多系统萎缩P型伴排尿异常患者膀胱功能的尿动力学研究

Urodynamic evaluation of bladder function in patients with parkinsonism dominant multiple system atrophy with abnormal urination

目的探讨多系统萎缩P(MSA-P)型伴排尿异常患者膀胱功能的尿动力学特点及其临床意义。方法分析2015年1月至2018年6月在郑州大学第一附属医院住院治疗的58例MSA-P型伴排尿异常患者的临床资料,评估MSA-P型患者的膀胱功能状态并分析其尿动力检查结果特点。结果所有患者均为男性。根据诊断标准,58例中拟诊51例,可疑7例;所有患者均诊断为MSA-P型。所有MSA-P型患者均出现不同症状的排尿异常,包括排尿困难(77.6%)、尿频(62.1%)、尿急(62.1%)、尿失禁(65.5%)、尿潴留(12.1%)。在MSA-P型伴排尿异常所有病例尿动力检查结果中,最大尿流率、平均尿流率、排尿量、膀胱残余尿量、最大逼尿肌收缩压、膀胱顺应性、正常尿意膀胱容量、最大膀胱容量依次为(12.46±2.85)ml/s、(5.19±2.06)ml/s、(171.73±11.47)ml、(136.15±10.47)ml、(20.78±3.55)cmH2O、(16.59±2.91)ml/cmH2O、(223.64±11.02)ml、(287.57±12.51)ml。MSA-P型伴排尿异常患者最大尿流率、平均尿流率、排尿量、最大逼尿肌收缩压、膀胱顺应性、正常尿意膀胱容量、最大膀胱容量明显低于正常参考值,而膀胱残余尿量明显高于正常参考值(均P<0.05)。结论MSA-P型伴排尿异常患者的膀胱功能尿动力学特点主要表现为膀胱顺应性下降和逼尿肌功能异常,而尿动力学检查有助于早期诊断。

Objective To investigate the urodynamic characteristics and clinical significance of bladder function in patients with parkinsonism dominant multiple system atrophy(MSA-P)with abnormal urination.Methods The clinical data of 58 patients with multiple system atrophy(MSA)and urinary dysfunction who were hospitalized in the First Affiliated Hospital of Zhengzhou University from January 2015 to June 2018 were analyzed.The bladder function status of MSA-P patients was evaluated,and the characteristics of urinary motility examination results were analyzed.Results According to the diagnostic criteria,51 patients were MSA,and seven patients were suspicious,all diagnosed as MSA-P.All MSA-P patients had abnormal urination with different symptoms,including dysuria(77.6%),frequent urination(62.1%),urgency(62.1%),urinary incontinence(65.5%),urinary retention(12.1%).Of the MSA-P patients with abnormal urination,the maximum flow rate(Qmax)was(12.46±2.85)ml/s,the average flow rate(Qave)was(5.19±2.06)ml/s,the voided volume was(171.73±11.47)ml,postvoid residual urine was(136.15±10.47)ml,maximal detrusor pressure was(20.78±3.55)cmH2O,bladder compliance was(16.59±2.91)ml/cmH2O,normal desire to void was(223.64±11.02)ml,and maximal capacity was(287.57±12.51)ml.The Qmax,Qave,voided volume,maximal detrusor pressure,bladder compliance,normal desire to void,and maximal capacity of patients with MSA-P with abnormal urination were significantly decreased,while the bladder residual urine volume was significantly increased,with statistically significant differences compared to normal reference values(P<0.05).Conclusion The urinary motility of bladder function in patients with MSA-P and urinary abnormalities is mainly characterized by decreased bladder compliance and detrusor dysfunction,while urodynamic testing is helpful for early diagnosis.