成年男性和女性夜间遗尿症患者的临床特点分析

The clinical features of nocturnal enuresis in adult men and women

目的探讨成年男性和女性夜间遗尿症(NE)患者的临床特点。方法本研究采用横断面设计,收集2017年9月至2020年12月于长海医院就诊的NE患者。纳入标准:年龄≥18岁,NE每周发生≥1次,且症状持续时间≥3个月。排除标准:活动性尿路感染、下尿路占位性病变、尿路的解剖结构异常、存在急性脏器功能衰竭及脑血管意外等严重疾病、非正常睡眠周期的夜班工作者。采集的基本信息包括身高、体重、药物史、手术史及合并疾病情况。采用3 d排尿日记中的次均尿量、排尿次数、夜间多尿(NP)指数、夜尿膀胱容量(NBC)指数等定量参数评估患者的排尿特征,采用尿动力学检查评估膀胱出口梗阻(BOO)、膀胱收缩力及控尿功能。结果本研究共纳入106例患者,男43例,女63例。男性和女性的平均年龄分别为(57.8±15.6)岁和(56.1±14.0)岁,体质指数(BMI)分别为(23.9±3.4)kg/m2和(23.3±4.3)kg/m2,差异均无统计学意义(P>0.05)。85例(80.2%)合并全身慢性疾病,以高血压病(58例,54.7%)、高脂血症(41例,38.7%)、糖尿病(38例,35.8%)、冠心病(22例,20.8%)最常见。男性合并症患病率[88.4%(38/43)与74.6%(47/63),P<0.05]和≥2种合并症患病率[62.8%(27/43)与33.3%(21/63),P<0.05]均高于女性。排尿日记结果显示,NE患者常合并有NP(47/106,44.3%)、NBC降低(74/106,69.8%),或两者并存(33/106,31.3%)。尿动力学检查结果显示,低顺应性膀胱、逼尿肌过度活动、压力性尿失禁、BOO、逼尿肌收缩力减弱(DU)和逼尿肌反射亢进伴收缩力受损(DHIC)的总体发生率分别为27.4%(29/106)、39.6%(42/106)、17.9%(19/106)、9.4%(10/106)、25.5%(27/106)和15.1%(16/106)。女性NE患者压力性尿失禁的发生率高于男性[28.6%(18/63)与2.3%(1/43),P<0.01],而男性NE患者BOO发生率高于女性[23.3%(10/43)与0,P<0.01]。相关性分析结果显示,肥胖(r=0.63,P<0.01)、合并疾病(r=0.40,P<0.01)、合并疾病数量(r=0.56,P<0.01)、存在NP(r=0.50,P<0.01)、存在NP合并NBC降低(r=0.47,P<0.01)、残余尿量(r=0.53,P<0.01)、膀胱顺应性降低(r=0.21,P=0.04)、伴DU(r=0.28,P<0.01)、伴压力性尿失禁(r=0.42,P<0.01)、伴DHIC(r=0.35,P<0.01)与NE次数增加呈正相关;最大尿流率降低(r=-0.35,P<0.01)、小膀胱容量(r=0.21,P=0.03)、膀胱敏感性升高(r=-0.21,P=0.03)与NE次数呈负相关。结论成人NE不仅与膀胱功能障碍相关,还与肥胖、慢性全身性疾病、液体代谢和尿液产生等因素密不可分,且男女患者各具特点,应予以整体化、个体化的评估与治疗。

Objective To discover the clinical features of nocturnal enuresis(NE)in adults and to detect factors that correlated with the symptom severity.Methods This cross-sectional study recruited NE subjects from September 2017 through December 2020.All patients had experienced enuresis at least once per week and with a symptom duration of 3 months or longer.Followed by documentation of history and medical records,three-day bladder diary was adopted to assess their voiding pattern,and urodynamic parameters were obtained to evaluate lower urinary tract function.Results A total of 106 NE patients(43 male and 63 female)were identified.There is no statistical difference regarding the average age(men:57.8±15.6 vs.women:56.1±14.0,P>0.05)and BMI(men:23.9±3.4 vs.women:23.3±4.3,P>0.05)between men and women.Comorbidities are extremely common in NE patients(n=85,80.2%),with the incidence rate higher in men compared to women[88.4%(38/43)vs.74.6%(47/63),P<0.05].Hypertension(n=58,54.7%),hyperlipemia(n=41,38.7%),diabetes mellitus(n=38,35.8%),coronary heart disease(n=22,20.8%)were the most frequently reported conditions.On bladder diaries,subjects were frequently manifested nocturnal polyuria(NP,47/106,44.3%),reduced nocturnal bladder capacity(NBC,74/106,69.8%),or combination of both(33/106,31.3%).Urodynamic studies suggested that the incidence of reduce bladder compliance,detrusor overactivity(DO),stress incontinence,bladder outlet obstruction(BOO),detrusor underactivity(DU)and detrusor hyperreflexia with impaired contractility(DHIC)was 27.4%(29/106),39.6%(42/106),17.9%(19/106),9.4%(10/106),25.5%(27/106)and 15.1%(16/106),respectively.Women were more likely to suffer from stress urinary incontinence[2.3%(1/43)men vs.28.6%(18/63)women,P<0.01],while men were prone to have bladder outlet obstruction[23.3%(10/43)men vs.0 women,P<0.01].Correlation analysis demonstrated that obesity(r=0.63,P<0.01),systemic comorbidities(r=0.40,P<0.01),presence of NP(r=0.50,P<0.01)and NP+NBC(r=0.47,P<0.01),post-void residual(r=0.53,P<0.01),reduced compliance(r=0.21,P=0.04),DU(r=0.28,P<0.01),stress incontinence(r=0.42,P<0.01)and DHIC(r=0.35,P<0.01)are positively correlated with NE severity.Whereas,reduced Qmax(r=-0.35,P<0.01),low capacity(r=0.21,P=0.03),and reduced bladder sensation(r=-0.21,P=0.03)correlate negatively with NE severity.Conclusions The presence of NE is not only a sign of bladder dysfunction,but also an implication of obesity,systematic chronic diseases,urine production malfunctioning.Therefore,a thorough history regarding the lower urinary tract function and systemic comorbidities should be taken carefully,so that,an integrated and personalized treatment can be carried out.