女性压力性尿失禁与神经-肌肉疲劳关系的研究

The Relationship Between Nerve-muscle Fatigue and Stress Urinary Incontinence in Women

压力性尿失禁(SUI)是女性常见病,神经-肌肉疲劳可能是其主要发病机制之一。应力状态下,尿道和盆底的横纹肌在维持尿道内压中起重要作用,骨骼肌运动易产生神经-肌肉疲劳。能源物质消耗、代谢产物积聚、神经-肌肉接点失衡引起骨骼肌外周性疲劳,中枢神经系统递质5-羟色胺(5-HT)、多巴胺(DA)和去甲肾上腺素(NA)等是导致中枢性疲劳的主要神经生物学因素,并从中枢性疲劳探讨度洛西汀治疗SUI的机制和疗效欠佳的原因,指明NA可能是SUI药物治疗的新研究方向。

The periurethral and pelvic striated muscles are the main regulators of urinary continence.These muscles produce an elevation in urethral pressure which allows the maintenance of a positive urothral-bladder pressure gradient during stress. Since all skeletal muscles are affected by neuromuscular fatigue, it can be hypothesized that nerve-muscle fatigue may play a role in the pathophysiology of stress urinary incontinence （SUI） in women. Energetic Materials consumption, metabolite accumulation and neuromuscular junction disbalance contribute to peripheral fatigue of skeletal muscles, while neurotransmitters produced by the central nervous system, such as 5- hydroxytryptamine （5-HT）, dopamine （DA） and noradrenaline （NA）, lead to central fatigue. Adopting the hypothesis that central fatigue is important in SUI, we discuss the therapeutic mechanism of Duloxetine treatment for SUI, and the causes of poor patient response. We predict that the use of NA may improve the treatment of SUI.