静息态近红外光谱脑功能成像对膀胱腔内电刺激治疗膀胱活动低下症的大脑皮层机制研究  

Cerebral cortex mechanism of resting-state functional near-infrared spectroscopy in the treatment of underactive bladder with intravesical electrical stimulation

作　　者：邓函 廖利民[1] 李兴 吴娟[1] 万里[1] 刘一茜 Deng Han;Liao Limin;Li Xing;Wu Juan;Wan Li;Liu Yixi(Department of Urology,China Rehabilitation Research Center,Bejing Boai Hospital,Urology and Pelvic Floor Rehabilitation Center,China Rehabilitation Science Institute,Bejing 100068,China)

机构地区：[1]中国康复研究中心北京博爱医院泌尿外科/泌尿与盆底康复中心、中国康复科学所,北京100068

出　　处：《中华泌尿外科杂志》2024年第9期664-670,共7页Chinese Journal of Urology

基　　金：首都卫生发展科研专项课题(首发2022-1-6011)。

摘　　要：目的探索膀胱腔内电刺激(IVES)治疗神经源性膀胱活动低下症(UAB)的大脑皮层机制。方法采用前瞻性研究方法对2022年3月至2023年6月北京博爱医院招募的健康受试者(HS)和接受IVES治疗的神经源性UAB患者进行研究。HS纳入标准:18~60岁女性;72 h排尿日记正常;尿量200~400 ml,自由尿流率>20 ml/s。HS排除标准:泌尿和神经系统相关疾病;全身各系统重大疾病;认知功能障碍。UAB患者纳入标准:18~60岁女性;不完全性脊髓损伤(D级或E级)所致神经源性UAB,病程>3个月;既往常规使用间歇导尿,或具有间歇导尿指征(残余尿量占功能膀胱容量的40%以上)。UAB患者排除标准:尿动力学检查示膀胱顺应性降低;症状性泌尿系感染;合并肾积水、膀胱-输尿管反流或肾功能不全(血肌酐大于正常值上限的1.5倍);膀胱肿瘤;神经系统相关疾病;孕妇或备孕;体内已植入起搏器或除颤器。基线时,记录所有受试者24 h排尿日记、残余尿量、排尿效率、初次膀胱充盈感容量和美国泌尿协会症状指数生活质量(AUA-SI-QOL)评分,完成膀胱空虚状态和强烈排空感状态前额叶静息态近红外光谱脑功能成像扫描。UAB组在完成20次IVES后再次评估上述指标。残余尿量改善>50%被定义为IVES治疗成功。对IVES治疗成功患者(成功UAB组)治疗前后以及成功UAB组与HS组前额叶内部功能连接差异进行比较。结果共纳入16例HS和18例UAB患者,IVES治疗后,11例UAB患者治疗成功,7例UAB患者治疗失败。成功UAB组治疗后较治疗前残余尿量[90.0(50.0,120.0)ml与210.0(110.0,300.0)ml]、24 h间歇导尿次数[3.0(2.0,4.0)次与4.0(3.0,4.0)次]、初次膀胱充盈感容量[275.0(245.0,280.0)ml与295.0(290.0,315.0)ml]和AUA-SI-QOL评分[2.0(2.0,3.0)分与4.0(4.0,4.0)分]均显著降低(P<0.05),排尿效率[75.0%(69.0%,85.0%)与42.0%(35.0%,77.0%)]显著升高(P<0.05)。IVES治疗前成功UAB组与HS组相比,前额叶内部功能连接在膀胱空虚状�Objective To explore the cerebral cortical mechanism of intravesical electrical stimulation(IVES)on neurogenic underactive bladder(UAB).Methods Aprospective study was conducted on healthy subjects(HS)recruited in our center and patients with neurogenic UAB treated with IVES from March 2022 to June 2023 were included.HS inclusion criteria:females aged 18-60 years;the 72-hour voiding diary was normal;the urine volume was 200-400 ml,and the free urine flow rate>20 ml/s.HS exclusion criteria:urinary and neurological related disorders;major diseases of all systems of the body;cognitive dysfunction.Inclusion criteria for UAB patients:females aged 18-60 years;neurogenic UAB due to incomplete spinal cord injury(grade D or E)with a duration of>3 months;previous routine use of intermittent catheterization,or indication of intermittent catheterization(residual urine accounts for>40%of functional bladder capacity).Exclusion criteria for UAB patients:decreased bladder compliance on urodynamic examination;symptomatic urinary tract infection;concomitant hydronephrosis,vesicoureteral reflux or renal insufficiency(serum creatinine greater than 1.5 times of the normal upper limit);bladder tumors;neurological related diseases;pregnant or trying to conceive;a pacemaker or defibrillator has been implanted in the body.At baseline,the 24-hour voiding diary,residual urine,voiding efficiency,first sensation of bladder filling volume and American Urological Association Symptom Index Quality of Life scores(AUA-SIQOL)were recorded,and the resting state-functional near-infrared spectroscopy scans of the prefrontal cortex was completed in the bladder emptying state and the strong desire to void stage.The UAB group was re-evaluated after completing 20 IVES treatments.Improvement in residual urine>50%was defined as success of IVES treatment.The differences in functional connectivity in the prefrontal lobe between the successful UAB group before and after IVES and between the successful UAB group and the HS group were compared.Results A total of

关 键 词：神经源性 膀胱腔内电刺激 膀胱活动低下症 近红外光谱脑功能成像 

分 类 号：R694[医药卫生—泌尿科学]