多发性硬化和视神经脊髓炎谱系疾病患者二便功能异常调查分析  

Investigations and analysis of the abnormalities of urination and defecation function in patients with multiple sclerosis and neuromyelitis optica spectrum disorders

作　　者：李至泓 仝延萍 杨涛[2] 李理[2] 魏薇 张晓寒 刘星佑 樊泓佑 毕豪杰 周思彤 樊永平[2] LI Zhihong;TONG Yanping;YANG Tao;LI Li;WEI Wei;ZHANG Xiaohan;LIU Xingyou;FAN Hongyou;BI Haojie;ZHOU Sitong;FAN Yongping(Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China;Department of Traditional Chinese Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]北京中医药大学东直门医院,北京100700 [2]首都医科大学附属北京天坛医院中医科,北京100070

出　　处：《中华中医药杂志》2024年第12期6695-6699,共5页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金项目(No.82074350);第六批北京市级中医药专家学术经验继承工作。

摘　　要：目的:通过调查多发性硬化(MS)和视神经脊髓炎谱系疾病(NMOSD)患者二便功能异常情况,以探寻“脑-肾-肠/膀胱”之间的联系。方法:纳入2023年11月至2024年5月就诊于首都医科大学附属北京天坛医院中医科的MS和NMOSD患者204例,采用门诊面询、电话与电子调查问卷,结合病历资料,收集并统计患者的人口学与临床资料、临床特点、影像学检查结果、二便情况、生活质量情况等。结果:204例患者中共有119例(58.3%)存在二便功能异常,其中,便秘/排便困难75例(63.0%),大便失禁8例(6.7%),尿等待/排尿延迟40例(33.6%),尿频尿急/尿失禁71例(59.7%),同时有47例(39.5%)患者至少存在1种膀胱和1种肠道功能症状共存。二便功能异常患者中有77例(64.7%)为肝肾阴虚型。Logistic逐步回归分析结果显示,大脑、延髓、颈髓、胸髓位置的病灶是导致大便异常发生的独立危险因素(P<0.01,P<0.05);年龄及大脑、小脑、延髓、颈髓、胸髓位置的病灶是小便异常发生的独立危险因素(P<0.01,P<0.05)。结论:MS和NMOSD患者二便功能异常与肾虚相关,有大脑和脊髓病灶的患者更容易出现二便功能异常。Objective:To investigate the link between‘brain-kidney-bowel/bladder’by investigating the abnormalities of urination and defecation function in patients with multiple sclerosis(MS)and neuromyelitis optica spectrum disorder(NMOSD).Methods:A total of 204 patients with MS and NMOSD who attended the Department of Traditional Chinese Medicine,Beijing Tiantan Hospital,Capital Medical University from November 2023 to May 2024 were enrolled,and demographic and clinical data,clinical characteristics,imaging findings,diarrhea,and quality of life were collected and counted using outpatient faceto-face interviews,telephone calls,and electronic questionnaires in conjunction with the information from the medical records.Results:A total of 119(58.3%)of the 204 patients had diastasis,including 75(63.0%)cases of constipation and dyspareunia,8(6.7%)cases of fecal incontinence,40(33.6%)cases of waiting for urine and delayed micturition,71(59.7%)cases of urinary frequency and urgency and incontinence,while 47(39.5%)of the patients had at least one bladder and one bowel function symptoms coexisted.A total of 77(64.7%)of the patients with the abnormalities of urination and defecation function were of the liver and kidney yin deficiency type.Logistic stepwise regression analysis showed that lesions in the cerebrum,medulla oblongata,cervical spinal cord,and thoracic cord were the independent risk factors leading to the development of the abnormality of defecation(P<0.01,P<0.05);age,and the presence of a lesion in the cerebrum,cerebellum,medulla oblongata,cervical spinal cord,and thoracic cord were independent risk factors for the development of the abnormality of urination(P<0.01,P<0.05).Conclusion:The abnormalities of urination and defecation function in MS and NMOSD patients is associated with kidney deficiency,and patients with brain and spinal cord lesions are more likely to develop the abnormalities of urination and defecation function.

关 键 词：多发性硬化 视神经脊髓炎谱系疾病 二便功能异常 Logistic回归分析 中枢神经系统疾病 证型 脑-肾-肠/膀胱 横断面调查 

分 类 号：R73[医药卫生—肿瘤]