根治性前列腺切除术后勃起功能障碍的相关因素筛查及临床风险评估模型的构建：一项回顾性研究。

Screening of Associated Factors for Erectile Dysfunction after Radical Prostatectomy and Construction of a Clinical Risk Assessment Model: A Retrospective Study.

机构信息

Department of Urology Ⅳ, Hunan Provincial People's Hospital (The First Hospital Affiliated of Hunan Normal University), 410000 Changsha, Hunan, China.

出版信息

Arch Esp Urol. 2024 Jan;77(1):92-97. doi: 10.56434/j.arch.esp.urol.20247701.12.

DOI:10.56434/j.arch.esp.urol.20247701.12

PMID:38374018

Abstract

OBJECTIVE

In this article, the associated factors for erectile dysfunction (ED) after radical prostatectomy (RP) were explored, and a clinical risk assessment model was constructed.

METHODS

A total of 155 patients who underwent RP in People's Hospital of Hunan Province from November 2020, to November 2021, were selected as the study group. In accordance with the results of International Index of Erectile Function (IIEF-5) at 6 months after surgery, 88 patients were included in the ED group (IIEF-5 <22), and 67 patients were included in the non-ED group (IIEF-5 ≥22). Univariate and multivariate logistic regression analyses were conducted to screen the risk factors for ED after RP, and a risk model was constructed on this basis. In addition, 43 patients with ED after RP and 41 patients with non-ED after RP from January 2022, to January 2023, were included in the test group to evaluate the predictive efficacy of the clinical risk assessment model on the basis of the receiver operating characteristic curve.

RESULTS

The study group had a lower postoperative IIEF-5 score than before surgery ( < 0.001). The incidence of ED after RP in the study group was 56.77% (88/155). Multivariate analysis showed that advanced age (odds ratio (OR) = 1.155), large prostate volume (OR = 1.077), smoking (OR = 5.676), drinking (OR = 3.495), hypertension (OR = 8.079), diabetes (OR = 6.082), low preoperative serum testosterone (T) level (OR = 0.684) and high preoperative serum endothelin-1 (ET-1) level (OR = 1.192) were risk factors for ED after RP ( < 0.05). A risk model was constructed as follows: Z = 0.144 × (age) + 0.074 × (prostate volume) + 1.736 × (smoking) + 1.251 × (drinking) + 2.089 × (hypertension) + 1.805 × (diabetes) - 0.380 × (preoperative serum T) + 0.175 × (preoperative serum ET-1). The area under curve (AUC), sensitivity, specificity and 95% CI of this model were 0.906, 97.70%, 73.20%, and 0.848-0.964, respectively ( < 0.001).

CONCLUSIONS

The clinical risk assessment model constructed on the basis of the above factors provides some references for the scientific prevention and treatment of ED after RP.

摘要

目的

探讨前列腺根治术后勃起功能障碍（ED）的相关因素，并构建临床风险评估模型。

方法

选取 2020 年 11 月至 2021 年 11 月湖南省人民医院收治的 155 例行前列腺根治术的患者为研究组。根据术后 6 个月国际勃起功能指数（IIEF-5）的结果，88 例患者被纳入 ED 组（IIEF-5＜22），67 例患者被纳入非 ED 组（IIEF-5≥22）。采用单因素和多因素 logistic 回归分析筛选前列腺根治术后 ED 的危险因素，并在此基础上构建风险模型。此外，2022 年 1 月至 2023 年 1 月纳入 43 例前列腺根治术后 ED 患者和 41 例前列腺根治术后非 ED 患者作为试验组，通过受试者工作特征曲线评估临床风险评估模型对 ED 的预测效能。

结果

研究组患者术后 IIEF-5 评分低于术前（<0.001）。研究组患者前列腺根治术后 ED 的发生率为 56.77%（88/155）。多因素分析结果显示，年龄较大（比值比（OR）=1.155）、前列腺体积较大（OR=1.077）、吸烟（OR=5.676）、饮酒（OR=3.495）、高血压（OR=8.079）、糖尿病（OR=6.082）、术前血清睾酮（T）水平较低（OR=0.684）和术前血清内皮素-1（ET-1）水平较高（OR=1.192）是前列腺根治术后 ED 的危险因素（<0.05）。构建风险模型如下：Z=0.144×（年龄）+0.074×（前列腺体积）+1.736×（吸烟）+1.251×（饮酒）+2.089×（高血压）+1.805×（糖尿病）-0.380×（术前血清 T）+0.175×（术前血清 ET-1）。该模型的曲线下面积（AUC）、敏感度、特异度及 95%CI 分别为 0.906、97.70%、73.20%及 0.848-0.964（<0.001）。