帕金森病和多系统萎缩的下尿路症状特点  

Lower urinary tract symptoms in Parkinson's disease and multiple system atrophy

作　　者：杨梦婷 张志鹏[2] 武冬冬[1] 苏闻[1] 陈海波[1] Yang Mengting;Zhang Zhipeng;Wu Dongdong;Su Wen;Chen Haibo(Department of Neurology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,China Academy of Medical Sciences,Beijing 100005,China;Department of Urology,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,China Academy of Medical Sciences,Beijing 100005,China)

机构地区：[1]北京医院神经内科、国家老年医学中心、中国医学科学院老年医学研究院,北京100005 [2]北京医院泌尿外科国家老年医学中心中国医学科学院老年医学研究院,北京100005

出　　处：《中华老年医学杂志》2023年第7期867-871,共5页Chinese Journal of Geriatrics

摘　　要：帕金森病(PD)、多系统萎缩(MSA)是常见的帕金森综合征,有相似的临床表现,临床的鉴别诊断存在困难。下尿路症状是二者常见的非运动症状之一。MSA下尿路症状发病率更高,发病更早,排尿期更加突出。PD的泌尿障碍主要为中枢机制,导致膀胱过度活动症。MSA的病变范围更广,中枢和周围同时受累,导致膀胱过度活动症和严重的排尿障碍。尿动力学可评估膀胱和尿道功能,MSA有更突出的弱逼尿肌活动、残余尿量、早期出现尿道括约肌改变等。PD下尿路症状的治疗主要以抗胆碱能药物改善膀胱过度活动症,而残余尿量增多的MSA患者则主要通过间歇导尿来改善。本文对两者的下尿路症状的流行病学、病理机制、尿动力学和治疗的研究成果进行综述,以期协助鉴别诊断和治疗。Parkinson's disease(PD)and multiple system atrophy(MSA)are two common Parkinsonian syndromes with overlapping clinical manifestations,and clinical differential diagnosis is difficult.Lower urinary tract symptoms are one of the common non-motor symptoms of the two diseases.The incidence of lower urinary tract symptoms in MSA is higher,the onset is earlier,and the micturition period is more prominent.The urinary dysfunction in patients with PD is mainly caused by the central mechanism,leading to overactive bladder.MSA has more extensive lesions with both central and peripheral involvement,leading to overactive bladder and severe voiding dysfunction.Urodynamics can be used to evaluate bladder and urethral function.MSA has more prominent weak detrusor activity,residual urine volume,and early changes of urethral sphincter.The treatment of lower urinary tract symptoms in patients with PD is mainly based on anticholinergic drugs to improve overactive bladder,while in MSA patients with increased residual urine volume,intermittent catheterization is the main method to improve lower urinary tract symptoms.This article reviewed the epidemiology,pathological mechanism,urodynamics and treatment of lower urinary tract symptoms of the two diseases,so as to assist in their differential diagnosis and treatment.

关 键 词：帕金森病 多系统萎缩 下尿路症状 尿动力学 治疗 

分 类 号：R742.5[医药卫生—神经病学与精神病学]