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

作　　者：宋奇翔 李佳怡[2] 王磊 郝一茹 徐蕾 顾懿元 孟晓红[2] 刘智勇 薛蔚[2] Song Qixiang;Li Jiayi;Wang Lei;Hao Yiru;Xu Lei;Gu Yiyuan;Meng Xiaohong;Liu Zhiyong;Xue Wei(Department of Urology,Changhai Hospital Affiliated to Naval Medical University,Shanghai 200433,China;Department of Urology,Renji Hospital,Shanghai Jiao Tong University,School of Medicine,Shanghai 200127,China)

机构地区：[1]海军军医大学附属长海医院泌尿外科,200433 [2]上海交通大学医学院附属仁济医院泌尿外科,200127

出　　处：《中华泌尿外科杂志》2021年第6期462-467,共6页Chinese Journal of Urology

摘　　要：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)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 complian

关 键 词：夜尿症 夜间遗尿 下尿路症状 夜间多尿 夜间膀胱容量 排尿日记 尿动力学 

分 类 号：R694.53[医药卫生—泌尿科学]