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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 盧令一 | 抑制血管增壓素對尿失禁的影響 | 2015/2/26 下午 08:09:06 | 0 |
| 原 文 | 題 目 | The Effect of Angiotensin Inhibition on Urinary Incontinence: Data from the National Health and Nutrition Examination Survey (2001–2008) |
| 作 者 | Christopher S. Elliott and Craig V. Comiter | |
| 出 處 | Neurourology and Urodynamics 33:1178–1181 | |
| 出版日期 | Nov, 2014 | |
| 評 論 | Renin-Angiotensin System(腎素－血管增壓素系統，RAS)對血壓的控制以及心血管疾病的形成扮演非常重要的角色，殊不知RAS在膀胱及尿道括約肌也有非常重要的生理作用。在兔子與老鼠的實驗中，angiotensin II (Ang II)會增加膀胱逼尿肌及尿道括約肌的收縮力，目前推測OAB有一部分的成因可能與AngII有關。目前美國FDA核准以抑制RAS來降血壓藥物有兩大類：Angiotension converting enzyme inhibitors (ACEIs)以及 angiotensin receptor blockers (ARBs)，動物實驗證實這兩類藥物因為抑制逼尿肌收縮而會改善urge incontinence (UUI)，但是同時抑制尿道括約肌收縮，降低尿道壓力而會增加 stress urinary incontinence (SUI)的機會。然而這兩種藥物對人類排尿造成的影響從未評估過，所以作者藉由2001~2008 National Health and Nutrition Examination Survey (NHANES)男女各約8800位的數據來分析，結果十分有趣，發現：（一）無論男女，使用ACEI或是ARB都不會造成SUI；（二）對男性來說，不論服用ACEI或是ARB，都可以明顯降低UUI的頻率，但是服用其他降血壓藥則沒有相同的作用。而且服用ACEI或是ARB時間長短對降低UUI的效果並沒有差異，對PSA也不造成影響；（三）但是對女性來說，服用ACEI或是ARB對UUI反而沒有明顯改善的作用，只對多產且沒有SUI的婦女有幫忙。這篇文章的結果顯然引起編輯的興趣，一位認為服用ACEI或是ARB對女性UUI應該也有改善的效果；另一位則解釋了因為androgen與膀胱angiotensin II type 2 receptor(AT2)的表現有關，而且停經後婦女的RAS活性較男性為低，或許可以解釋為什麼男性服用ACEI或是ARB對UUI會有比較明顯的效果。 | |
| abstract |
Introduction: Local renin–angiotensin systems exist within the genitourinary tract, specifically in the bladder and urethra. Experimental data suggest that angiotensin receptor blockade with either angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) decreases both detrusor overactivity and urethral sphincter tone leading to decreased urge incontinence (UUI) and increased stress urinary incontinence (SUI). This has not been examined in a human population. Methods: Data from the National Health and Nutrition Examination Survey (NHANES) was accessed for the years 2001–2008. Multivariate logistic regression was used for modeling. Results: We studied 8,754 females and 8,886 males who met inclusion criteria. Use of ACE inhibitors or ARBs was not associated with a change in SUI in either men or women. In men, use of an ACE inhibitor or ARB was associated with a statistically significant 25–30% decrease in UUI (monthly or any urge incontinence). A similar, albeit non-significant trend was also seen for daily and weekly UUI. Other antihypertensive medications (diuretics, beta-blockers, calcium-channel blockers) were not associated with a decrease in UUI. In subanalysis, duration of ACE inhibitor or ARB use did not alter the strength of the effect on UUI nor did an elevated prostate specific antigen (PSA) level (used as a surrogate for bladder outlet obstruction due to benign prostatic hypertrophy). ACE inhibitor and ARB use did not affect UUI rates in women, though did show a trend for improvement in nulliparous women without SUI. Conclusion: Angiotensin receptor blockade may be a viable treatment approach for the treatment of UUI, especially in men. |
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