阴部神经电针联合托特罗定治疗女性膀胱过度活动症

The effect of perineal nerve electroacupuncture combined with tolterodine in the treatment of female overactive bladder

目的 研究阴部神经电针联合托特罗定治疗女性膀胱过度活动症(overactive bladder,OAB)的效果。方法 选取2020年4月至2021年5月于浙江中医药大学附属湖州中医院接受治疗的150例女性OAB患者,根据随机数字表法将其分为对照组和研究组,每组各75例。对照组患者使用托特罗定治疗,研究组患者使用阴部神经电针疗法联合托特罗定治疗。比较两组患者的临床症状、排尿症状、尿流动力学指标[最大膀胱测压容量(maximum cystometric capacity,MCC)、最大尿道闭合压(maximum urethral closure pressure,P)_(ura·clos·max)、最大逼尿肌压(maximum detrusor pressure,P_(det·max))、最大尿流率(maximum urine flow rate,Q_(max))]、膀胱功能指标(最初感觉容量、最大尿意容量)、神经生长因子(nerve growth factor,NGF)介导瞬时受体电位(transient receptor potential,TRP)通路指标[NGF、NGF/尿肌酐(urine creatinine,UCr)、TRPV1、TRPV4]及临床疗效。结果 治疗后,研究组患者的夜间排尿次数、尿急次数均显著少于对照组,均次排尿量显著多于对照组(P<0.05)。研究组患者的膀胱过度活动症状评分、视觉模拟评分法评分均显著低于对照组(P<0.05)。研究组患者的MCC、P_(ura·clos·max)显著高于对照组,P_(det·max)、Q_(max)显著低于对照组(P<0.05)。研究组患者的最初感觉容量和最大尿意容量均显著大于对照组(P<0.05)。研究组患者的NGF、NGF/UCr、TRPV1和TRPV4阳性表达率均显著低于对照组(P<0.05)。研究组患者的总有效率显著高于对照组(χ^(2)=5.374,P=0.020)。两组患者的总不良反应发生率比较差异无统计学意义(χ^(2)=0.362,P=0.547)。结论 阴部神经电针疗法联合托特罗定可显著改善女性OAB患者的膀胱功能,抑制临床症状,其可通过抑制NGF介导的TRP通道蛋白TRPV1、TRPV4增高所致的膀胱敏感度发挥作用。

Objective To investigate the effect of perineal nerve electroacupuncture combined with tolterodine in the treatment of female overactive bladder(OAB).Methods A total of 150 female OAB patients treated in Huzhou Hospital of Traditional Chinese Medicine,Zhejiang Chinese Medical University from April 2020 to May 2021 were selected and divided into control group and study group according to random number table method,with 75 cases in each group.The control group was treated with tolterodine,and the study group was treated with pudendal nerve electroacupuncture combined with tolterodine.Clinical symptoms,urinary symptoms,and urodynamic indicators [maximum cystometric capacity(MCC),maximum urethral closure pressure(P_(ura clos max)),maximum detrusor pressure(P_(det max)),and maximum urine flow rate(Q_(max))],bladder function indicators(initial bladder sensation volume,bladder volume during strong micturition desire),nerve growth factor(NGF) mediated transient receptor potential(TRP) pathway indicators [NGF,NGF/urine creatinine(UCr),TRPV1,TRPV4] and clinical efficacy of two groups were compared.Results After treatment,the number of night urination and urgent urination in study group were significantly less than those in control group,and the average volume of urination was significantly more than that in control group(P<0.05).The overactive bladder symptom scores and visual analogue scale scores of study group were significantly lower than those of control group(P<0.05).The MCC and P_(ura·clos·max) in study group were significantly higher than those in control group,while P_(det·max) and Q_(max) were significantly lower than those in control group(P<0.05).The initial bladder sensation volume and bladder volume during strong micturition desire in study group were higher than those in control group(P<0.05).NGF,NGF/UCr,positive expression rates of TRPV1 and TRPV4 in study group were lower than those in control group(P<0.05).The total effective rate was significantly higher in study group than in control group,(χ~2=5.374,P=0.020).There was no significant difference in the incidence of total adverse reactions between two groups(χ~2=0.362,P=0.547).Conclusion Perineal nerve electroacupuncture combined with tolterodine can significantly improve bladder function and inhibit clinical symptoms in female OAB patients,possibly by inhibiting bladder sensitivity caused by NGF-mediated increase of TRP channel proteins TRPV1 and TRPV4.