高 EDSS 可预测多发性硬化症患者发生上尿路损伤的风险。

High EDSS can predict risk for upper urinary tract damage in patients with multiple sclerosis.

机构信息

Brain Research Institute, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland/Department of Neurology, University Hospital Zürich, Zürich, Switzerland.

Brain Research Institute, University of Zürich and Department of Health Sciences and Technology, Swiss Federal Institute of Technology Zürich, Zürich, Switzerland/Neuro-Urology, Spinal Cord Injury Center & Research, University of Zürich, Balgrist University Hospital, Zürich, Switzerland.

出版信息

Mult Scler. 2018 Apr;24(4):529-534. doi: 10.1177/1352458517703801. Epub 2017 Apr 3.

DOI:10.1177/1352458517703801

PMID:28367674

Abstract

BACKGROUND

Neurogenic lower urinary tract dysfunction (NLUTD) is very common in patients with multiple sclerosis (MS), and it might jeopardize renal function and thereby increase mortality. Although there are well-known urodynamic risk factors for upper urinary tract damage, no clinical prediction parameters are available.

OBJECTIVE

We aimed to assess clinical parameters potentially predicting urodynamic risk factors for upper urinary tract damage.

METHODS

A consecutive series of 141 patients with MS referred from neurologists for primary neuro-urological work-up including urodynamics were prospectively evaluated. Clinical parameters taken into account were age, sex, duration, and clinical course of MS and Expanded Disability Status Scale (EDSS).

RESULTS

Multivariate modeling revealed EDSS as a clinical parameter significantly associated with urodynamic risk factors for upper urinary tract damage (odds ratio = 1.34, 95% confidence interval (CI) = 1.06-1.71, p = 0.02). Using receiver operator characteristic (ROC) curves, an EDSS of 5.0 as cutoff showed a sensitivity of 86%-87% and a specificity of 52% for at least one urodynamic risk factor for upper urinary tract damage.

CONCLUSION

High EDSS is significantly associated with urodynamic risk factors for upper urinary tract damage and allows a risk-dependent stratification in daily neurological clinical practice to identify MS patients requiring further neuro-urological assessment and treatment.

摘要

背景

神经原性下尿路功能障碍（NLUTD）在多发性硬化症（MS）患者中非常常见，可能危及肾功能并因此增加死亡率。尽管存在众所周知的上尿路损伤的尿动力学危险因素，但目前尚无临床预测参数。

目的

我们旨在评估可能预测上尿路损伤尿动力学危险因素的临床参数。

方法

连续系列的 141 例 MS 患者由神经科医生转诊进行主要神经泌尿学检查，包括尿动力学检查。考虑的临床参数包括年龄、性别、MS 的病程和扩展残疾状态量表（EDSS）的持续时间和临床病程。

结果

多变量模型显示 EDSS 是与上尿路损伤尿动力学危险因素显著相关的临床参数（优势比=1.34，95%置信区间（CI）=1.06-1.71，p=0.02）。使用接收者操作特征（ROC）曲线，EDSS 为 5.0 作为截定点，对上尿路损伤的至少一个尿动力学危险因素的敏感性为 86%-87%，特异性为 52%。