原发性夜间遗尿症神经电生理研究及其临床意义

The neurophysiological study on children with primary nocturnal enuresis

目的探讨原发性夜间遗尿症骶神经兴奋性及传导功能改变与睡眠觉醒障碍的关系。方法原发性遗尿病人54例，男40例，女14例，年龄5～16岁，遗尿5次／月～3次／晚不等。同期选择住院儿童68例作为对照组，其中男50例，女18例，年龄5～15岁，无神经系统和下尿路异常症状。分别测定骶反射、阴部神经体感诱发电位、胫神经诱发电位。结果两组儿童均顺利诱发骶反射，但遗尿组刺激阈强度（58．75±10．91）mA，对照组却为（44．65±11．08）mA（P〈0．01）；同时，遗尿组潜伏期为（55．08±9．46）ms，对照组却为（35．33±5．50）ms（P〈0．001）；遗尿组记录到阴部神经体感诱发头皮电位46例（85．2％），对照组68例（100％）（P〈0．01）；不同年龄段遗尿儿童其阴部神经中枢传导时间，与对照组相应年龄段比较均有延长，青春期更为明显（P〈0．01），同时，遗尿组胫神经体感诱发电位潜伏期延长者14例（25．9％），对照组为0例。结论通过神经电生理检测，证实遗尿儿童骶神经兴奋性降低，上行传导功能障碍，导致膀胱充盈信息不能有效激发骶神经兴奋并将此兴奋信息及时上传至中枢，从而产生觉醒障碍，可能是小儿遗尿症的重要病理生理改变之一。

Objective To investigate the relationship between nervous conductive dysfunction and arousal disability, in children with primary nocturnal enuresis （PNE） by means of a neurophysiological study. Methods 54 children with PNE （40 boys and 14 girls, age ranged from 5 to 16 years） were enrolled in the study. Bed-wetting events occurred between 3 times per night to 5 times per month. Sixty-eight age-matched children without neurological and lower urinary tract symptoms were selected as controls. This group included 50 boys and 18 girls aged from 5 to 15 years. Sacral Reflect （SR）, Pudendal Somato -Sansory Evoked Potentials （PSSEP） and Tibial Somato-Sensory Evoked Potentials （TSSEP） were tested. Results All subjects successfully elicited SR. The threshold intensities for PNE vs. the control were（ 58.75 ± 10. 91 ） mA and （ 44. 65 ± 11.08 ） mA, respectively （ P〈0. 01 ）. However the latency was（55.08 ± 9. 46）ms, and（35.33 ± 5.50）ms respectively, with a significant statistical difference （P〈0. 001 ）. Forty-six （85.2%） PNE patients recorded a PSSEP compared to 68 （100%） in the control（P〈0. 05）. Dividing the children into three groups, the latency of the central conductive time in every group of PNE was longer than that of the control, especially in the adolescent age group（P〈0. 01 ）. Fourteen patients showed a longer TSSEP latency in PNE, vs. none in the control. Conclusions The sacral nervous excitability and decrease in conductive velocity may play an important role in arousal dysfunction in children with PNE. They may predict the underlying lesion of afferent pathway.