摘要
目的探讨良性前列腺增生(BPH)患者术后阴茎勃起功能障碍(ED)发生的风险因素,并建立列线图模型及风险分层标准,为临床防治ED提供参考。方法回顾性分析2021年1月至2023年6月新乡医学院第一附属医院收治的120例BPH术后患者的临床资料,根据术后是否发生ED分组,其中ED组60例,非ED组60例。比较两组患者的临床资料,采用Logistic回归方程分析BPH患者术后ED发生的影响因素,采用R-3.4.5软件语言建立列线图模型,绘制受试者工作特征曲线(ROC)、校准曲线、曲线下面积(AUC)、决策曲线(DCA)分析列线图模型预测效能,采用递归分割法建立ED发生风险分层系统。结果ED组患者中合并高血压、抑郁症、糖尿病、下尿路症状≥2项的例数占比分别为46.67%、31.67%、43.33%、45.00%,明显高于非ED组的28.33%、15.00%、23.33%、25.00%,差异均有统计学意义(P<0.05);ED组患者的一氧化氮(NO)、睾酮(T)水平分别为(40.42±5.56)nmol/mL、(2.11±0.60)μg/L,明显低于非ED组的(46.78±6.12)nmol/mL、(2.72±0.81)μg/L,而内皮素-1(ET-1)水平为(71.88±8.89)ng/L,明显高于非ED组的(60.02±10.23)ng/L,差异均有统计学意义(P<0.05);ED组患者收缩期峰值流速(PSV)、舒张末期流速(EDV)、阻力指数(RI)分别为(7.56±2.27)cm/s、(20.23±3.58)cm/s、0.59±0.17,明显小于非ED组的(10.22±2.69)cm/s、(25.51±4.36)cm/s、0.78±0.23,差异均有统计学意义(P<0.05);Logistic回归分析结果提示,高血压、抑郁症、糖尿病、NO、ET-1、T均是BPH术后ED发生风险的影响因素(P<0.05);基于上述影响因素构建的BPH术后ED发生风险的列线图预测模型的AUC为0.862,95%CI为0.796~0.927;DCA曲线显示该模型具有正向净获益;危险分层分析结果显示,高风险患者ED发生率为85.71%(36/42),高于中等风险的32.56%(14/43)和低风险的28.57%(10/35),差异有统计学意义(P<0.05)。结论高血压、抑郁症、糖尿病、NO、ET-1、T均是BPH术后ED发生风险的影响因素,
Objective To explore the risk factors for the occurrence of erectile dysfunction(ED)in patients with benign prostatic hyperplasia(BPH)after surgery,and establish a nomogram model and risk stratification criteria to provide a reference for clinical prevention and treatment of ED.Methods The clinical data of 120 patients with BPH after surgery admitted to the First Affiliated Hospital of Xinxiang Medical University from January 2021 to June 2023 were retrospectively analyzed.According to whether ED occurred after surgery,the patients were divided into two groups:60 patients in the ED group and 60 patients in the non-ED group.The clinical data of the two groups of patients were compared,and the Logistic regression equation was used to analyze the influencing factors of ED occurrence in BPH patients after surgery.The R-3.4.5 software language was used to establish a nomogram model,and the receiver operating characteristic(ROC)curve,calibration curve,area under the curve(AUC),decision curve analysis(DCA)were used to analyze the predictive efficacy of the nomogram model.The recursive partitioning method was used to establish a risk stratification system for ED occurrence.Results The proportions of patients with hypertension,depression,diabetes,and lower urinary tract symptoms in the ED group were 46.67%,31.67%,43.33%,and 45.00%,respectively,which were significantly higher than 28.33%,15.00%,23.33%,and 25.00%in the non-ED group(P<0.05).The levels of nitric oxide(NO)and testosterone(T)in the ED group were(40.42±5.56)nmol/mL and(2.11±0.60)μg/L,respectively,which were significantly lower than(46.78±6.12)nmol/mL and(2.72±0.81)μg/L in the non-ED group,while the level of endothelin-1(ET-1)was(71.88±8.89)ng/L,which was significantly higher than(60.02±10.23)ng/L in the non-ED group, with statistically significant differences (P<0.05). The systolic peak flow velocity (PSV), end diastolic velocity(EDV), and resistance index (RI) in the ED group were (7.56±2.27) cm/s, (20.23±3.58) cm/s, and 0.59±0.17, respectively,which
作者
薛向东
韩广业
张春峰
余沁楠
侯国栋
唐钊
XUE Xiang-dong;HAN Guang-ye;ZHANG Chun-feng;YU Qin-nan;HOU Guo-dong;TANG Zhao(Department of Urology,the First Affiliated Hospital of Xinxiang Medical College,Xinxiang 453100,Henan,CHINA)
出处
《海南医学》
CAS
2024年第16期2325-2329,共5页
Hainan Medical Journal
基金
河南省医学科技攻关计划联合共建项目(编号:LHGJ20220607)。
关键词
良性前列腺增生术
阴茎勃起功能障碍
经尿道前列腺电切术
列线图模型
风险分层
影响因素
Benign prostatic hyperplasia
Penile erectile dysfunction
Transurethral resection of prostate
Nomogram model
Risk stratification
Influencing factor
