Xu Tao, Zhang Lei, Li Zhiyi, Zhu Lan, Han Shaomei
Department of Epidemiology and Statistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & School of Basic Medicine, Peking Union Medical College.
Department of Gynecology and Obstetrics, Peking Union Medical College Hospital, Peking Union Medical College.
Medicine (Baltimore). 2019 Oct;98(40):e17409. doi: 10.1097/MD.0000000000017409.
Lower urinary tract symptoms (LUTS) have detrimental impact on health-related quality of life. This study has 2 aims: first to identify the optimum model for LUTS study and then to explore the potential associated factors of LUTS and bother LUTS with the optimum model among adult women in China.The survey was conducted in 6 regions of China between February and July 2006. A modified Chinese Bristol Female LUTS questionnaire was administered. The number of LUTS was the main outcome measure. The fitting goodness was compared to identify the optimum model with likelihood ratio test statistics. Zero-inflated negative binomial (ZINB) model was used to explore the potential associated factors of LUTS and bother LUTS.Of all 18,992 respondents, 55.5% of respondents reported one (any LUTS) or more LUTS (mixed LUTS) and 36.5% of respondents reported one or more bother LUTS. With the largest log likelihood and smallest AIC and BIC, ZINB model showed the best goodness of fit. In the ZINB model, we identified multiple associated factors for any LUTS and mixed LUTS; older age (β≥0.2), overweight [β = 0.059, 95%CI (0.016∼0.102)], obese [β = 0.143, 95%CI (0.087∼0.198)], postmenopausal status [β = 0.099, 95%CI (0.023∼0.175)], prolonged labor [β = 0.188, 95%CI (0.104∼0.272)], constipation [β = 0.309, 95%CI (0.262∼0.357)], coexisting pelvic organ prolapse (POP) [β = 0.348, 95%CI (0.224∼0.473)], diabetes (β = 0.178, 95%CI (0.100∼0.257), hypertension [β = 0.092, 95%CI (0.041∼0.143)], smoking (β = 0.192, 95%CI (0.127∼0.258) and alcohol consumption [β = 0.063, 95%CI (0.001∼0.126)] increased the odds of mixed LUTS. We identified multiple associated factors for bother LUTS and mixed LUTS; older age (β ≥ 0.1), prolonged labor [β = 0.153, 95%CI (0.031∼0.275)], constipation [β = 0.359, 95%CI (0.292∼0.426)] coexisting POP (β = 0.212, [95%CI (0.031∼0.393)], diabetes [β = 0.154, 95%CI (0.030∼0.278)], and smoking [β = 0.169, 95%CI (0.076∼0.262)] increased the odds of bother mixed LUTS.ZINB model was the optimum model to explore the potential associated factors of LUTS. Older age, coexisting POP and constipation were both closely related to any and bother LUTS, also the severity of LUTS. Compared to nulliparity, single or multiple deliveries and women who had perineal laceration had nothing to do with the severity of LUTS.
下尿路症状（LUTS）对健康相关生活质量有不利影响。本研究有两个目的：一是确定LUTS研究的最佳模型，二是在中国成年女性中，利用该最佳模型探索LUTS的潜在相关因素以及困扰LUTS的因素。该调查于2006年2月至7月在中国6个地区进行。采用了经过修改的中国版布里斯托尔女性LUTS问卷。LUTS的数量是主要结局指标。通过似然比检验统计量比较拟合优度，以确定最佳模型。采用零膨胀负二项分布（ZINB）模型探索LUTS的潜在相关因素以及困扰LUTS的因素。
在所有18992名受访者中，55.5%的受访者报告有一项（任何LUTS）或多项LUTS（混合LUTS），36.5%的受访者报告有一项或多项困扰LUTS。ZINB模型具有最大对数似然值以及最小的AIC和BIC，显示出最佳的拟合优度。在ZINB模型中，我们确定了与任何LUTS和混合LUTS相关的多个因素；年龄较大（β≥0.2）、超重[β = 0.059，95%CI（0.016～0.102）]、肥胖[β = 0.143，95%CI（0.087～0.198）]、绝经后状态[β = 0.099，95%CI（0.023～0.175）]、产程延长[β = 0.188，95%CI（0.104～0.272）]、便秘[β = 0.309，95%CI（0.262～0.357）]、并存盆腔器官脱垂（POP）[β = 0.348，95%CI（0.224～0.473）]、糖尿病（β = 0.178，95%CI（0.100～0.257））、高血压[β = 0.092，95%CI（0.041～0.143）]、吸烟（β = 0.192，95%CI（0.127～0.258））和饮酒[β = 0.063，95%CI（0.001～0.126）]会增加混合LUTS的发生几率。我们确定了与困扰LUTS和混合LUTS相关的多个因素；年龄较大（β≥0.1）、产程延长[β = 0.153，95%CI（0.031～0.275）]、便秘[β = 0.359，95%CI（0.292～0.426）]、并存POP（β = 0.212，[95%CI（0.031～0.393）]）、糖尿病[β = 0.154，95%CI（0.030～0.278）]和吸烟[β = 0.169，95%CI（0.076～0.262）]会增加困扰混合LUTS的发生几率。
ZINB模型是探索LUTS潜在相关因素的最佳模型。年龄较大、并存POP和便秘均与任何LUTS及困扰LUTS密切相关，也与LUTS的严重程度密切相关。与未生育相比，单胎或多胎分娩以及有会阴裂伤的女性与LUTS的严重程度无关。
