近红外光谱：一种新型的、非侵入性的诊断方法，用于检测膀胱过度活动症患者的逼尿肌过度活动——初步和实验研究。
Near-infrared spectroscopy: a novel, noninvasive, diagnostic method for detrusor overactivity in patients with overactive bladder symptoms--a preliminary and experimental study.
机构信息
Department of Urology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
出版信息
Eur Urol. 2011 May;59(5):757-62. doi: 10.1016/j.eururo.2010.12.032. Epub 2010 Dec 29.
BACKGROUND
Near-infrared spectroscopy (NIRS) is an optical technology. It detects the hemodynamic changes in tissues via noninvasive measurement of changes in the concentration of tissue chromophores such as oxyhemoglobin (O(2)Hb) and deoxyhemoglobin (HHb). Involuntary bladder contractions may cause changes detectable by NIRS.
OBJECTIVE
To address the accuracy and reproducibility of NIRS to detect the hemodynamic effects of detrusor overactivity (DO).
DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was carried out on 41 patients with overactive bladder symptoms.
MEASUREMENTS
Forty-one patients underwent one or more filling cystometries with simultaneous NIRS of the bladder. The separated graphs representing both tests were presented to three urodynamicists on two occasions, 3 wk apart. The graphs showed curves with and without DO episodes with the bladder sensations marked. Thirteen of 47 graphs (28%) with DO and 16 of 58 graphs (28%) without DO were excluded due to motion artifacts. The urodynamicists marked pressure changes suggestive of DO on the cystometry curves. For NIRS curves they marked definite deviations from baseline. The sensitivity and specificity of NIRS for DO were determined. The inter- and intraobserver agreements were determined.
RESULTS AND LIMITATIONS
Valid data from 33 of 41 patients (80%) were included in the analysis. The interobserver agreement to trace the effect of DO on NIRS curves was "substantial" (κ(f)>0.6). The sensitivity of the Hb(sum) (O(2)Hb+HHb) curves for DO was 62-97% with a specificity of 62-79% (area under the curve [AUC]: 0.80-0.82; p<0.001). O(2)Hb curves had 79-85% sensitivity and 82-91% specificity for DO (AUC: 0.80-0.85; p<0.001). The sensitivity and specificity of the HHb curves for DO were 71-82% and 77-82%, respectively (AUC: 0.73-0.84; p<0.001). These values represent the performance of NIRS in the data sample that is not contaminated with motion artifacts; they are not representative of a general clinical setting.
CONCLUSION
NIRS is a potential noninvasive, reproducible, diagnostic method to detect DO.
背景
近红外光谱（NIRS）是一种光学技术。它通过无创测量组织色团（如氧合血红蛋白（O2Hb）和去氧血红蛋白（HHb））浓度的变化来检测组织的血液动力学变化。不自主的膀胱收缩可能会导致 NIRS 检测到的变化。
目的
探讨 NIRS 检测逼尿肌过度活动（DO）的血液动力学效应的准确性和可重复性。
设计、地点和参与者：对 41 例有膀胱过度活动症状的患者进行前瞻性队列研究。
测量
41 例患者接受了一次或多次充盈膀胱测压检查，并同时进行了膀胱 NIRS 检查。将代表这两项检查的分离图表呈现给三位尿动力学专家，两次检查相隔 3 周。这些图表显示了有和没有 DO 发作的曲线，同时标记了膀胱感觉。由于运动伪影，47 份 DO 图表中有 13 份（28%）和 58 份无 DO 图表中有 16 份（28%）被排除在外。尿动力学专家在膀胱测压曲线中标注了提示 DO 的压力变化。对于 NIRS 曲线，他们标记了与基线的明确偏差。确定了 NIRS 对 DO 的敏感性和特异性。确定了观察者间和观察者内的一致性。
结果和局限性
对 41 例患者中的 33 例（80%）进行了分析，纳入了有效数据。观察者间对 NIRS 曲线上 DO 效应的跟踪一致性为“中等”（κ（f）>0.6）。Hb（sum）（O2Hb+HHb）曲线对 DO 的敏感性为 62-97%，特异性为 62-79%（曲线下面积[AUC]：0.80-0.82；p<0.001）。O2Hb 曲线对 DO 的敏感性为 79-85%，特异性为 82-91%（AUC：0.80-0.85；p<0.001）。HHb 曲线对 DO 的敏感性和特异性分别为 71-82%和 77-82%（AUC：0.73-0.84；p<0.001）。这些值代表了在未受运动伪影污染的数据样本中 NIRS 的性能，它们不能代表一般临床环境。
结论
NIRS 是一种潜在的非侵入性、可重复、诊断 DO 的方法。
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