摘要
目的 探讨长期滥用氯胺酮导致上尿路功能损害的危险因素.方法 回顾性分析2009年9月至2015年7月确诊的氯胺酮相关性泌尿系损害患者103例的临床资料,男82例（79.6％）,女21例（20.4％）.年龄18 ～36岁,平均（23.9±3.6）岁.药物滥用时间0.3 ～9.2年,平均（3.4±2.1）年.LUTS病程1.0～84.0个月,平均（17.7±5.9）个月.根据诊断标准分为上尿路功能障碍组（39例）和上尿路功能正常组（64例）,比较组间一般资料（年龄、性别、体质指数）、吸食行为（吸食年限、吸食频率、平均吸食量、戒断时间）、LUTS病程、盆腔疼痛与尿急/尿频（PUF）评分、血液检测指标（WBC、ALT、AST、γ-GT）、排尿日记（日间排尿间隔时间、夜尿次数、平均尿量）、尿动力学检查（膀胱容量、残余尿量、峰值压力、尿流率、无抑制性收缩次数、顺应性）和影像学表现的差异.建立多元Logistic回归模型,分析氯胺酮相关性上尿路功能损害的危险因素.结果 上尿路功能障碍组与正常组相比,体质指数（t=2.127,P=0.043）、吸食频率（t=2.335,P=0.029）、戒断时间（t=3.451,P =0.003）、LUTS病程（t=2.289,P=0.036）、PUF评分（t=3.030,P=0.004）、γ-GT（t=2.697,P=0.012）、最大膀胱测压容积（t=5.056,P＜0.001）、最大尿道闭合压（t=3.015,P=0.008）、膀胱顺应性（t=8.562,P＜0.001）和膀胱挛缩影像学表现（x2=15.155,P＜0.001）等方面差异有统计学意义.Logistic回归分析显示,吸食频率（OR=1.279,P=0.038）、戒断时间（OR =0.394,P=0.028）、γ-GT（OR=1.007,P=0.032）、最大膀胱测压容积（OR =0.775,P=0.011）和膀胱顺应性（OR=0.013,P=0.008）等是影响上尿路功能的危险因素.结论 持续性频繁滥用药物、合并慢性淤积性胆管炎以及低容量低顺应性膀胱是氯胺酮相关性上尿路功能损害的危险因素.
Objective To identify the risk factors of chronic ketamine-induced upper urinary tract dysfunction （KUUTD）.Methods Medical records of 103 patients with ketamine-associated urinary dysfunction（KAUD） from Sep.2009 to Jul.2015 were retrospectively reviewed.All the patients were divided into the upper urinary tract dysfunction group（n =39）or the normal group（n =64）according to the diagnostic criteria.Indexes such as general features （age,gender,BMI）,drug-abusing characteristics （abusing time,frequency,dose,abstinent period）,duration of LUTS,pelvic pain and urgency/frequency symptom score（PUF score）,serum parameters （WBC,ALT,AST,γ-GT）,bladder diary （daytime inter-void interval,nocturia,average urine volume）,urodynamic data （maximum cystometric capacity,post-void residual,maximum urethral closure pressure,maximum and average flow rate,instable contraction,bladder compliance） and imaging manifestations were compared between the two groups.Logistic regression analysis was performed for the evaluation of variables with statistical significance.Results There was significantly difference between the two groups in BMI （t =2.127,P =0.043）,drug-abusing frequency （t =2.335,P =0.029）,abstinent period （t =3.451,P =0.003）,duration of LUTS （t =2.289,P =0.036）,PUF score （t =3.030,P =0.004）,γ-GT value（t =2.697,P =0.012）,MCC（t =5.056,P 〈 0.001）,MUCP（t =3.015,P =0.008）,BC （t =8.562,P 〈 0.001） and imaging findings of bladder contracture （x2 =15.155,P 〈0.001）.The multivariate Logistic regression analysis showed that drug-abusing frequency（OR =1.279,P =0.038）,abstinent period（OR =0.394,P =0.028）,γ-GT value （OR =1.007,P =0.032）,MCC （OR =0.775,P =0.011）and BC （OR =0.013,P =0.008）were the key factors of KUUTD.Conclusion Consecutive and frequent drug abuse,combination with chronic obstructive cholangitis,reduced capacity and low compliance bladder are the risk factors of upper urinary tract dysfunction associated with ketamine abuse.
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2016年第3期209-213,共5页
Chinese Journal of Urology
基金
国家自然科学基金（81100540）
广东省科技计划项目（2014A020212195）
