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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 林佑樺/廖俊厚醫師 | 膀胱過動症病患之非泌尿之系統性症狀 | 2016/7/1 下午 04:16:17 | 0 |
| 原 文 | 題 目 | Systemic Nonurological Symptoms in Patients with Overactive Bladder |
| 作 者 | H. Henry Lai, Joel Vetter, Sanjay Jain, Gerald L. Andriole | |
| 出 處 | Journal of Urology | |
| 出版日期 | Accepted for publication February 23, 2016. Published online: March 17, 2016 |
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| 評 論 |
膀胱過動症是造成男女性尿失禁的重要因素，膀胱過動症是指膀胱過度敏感或異常收縮，導致急尿（突然有強烈欲望想排尿）、頻尿（白天解尿次數超過8次以上）、夜尿（夜間起床小便兩次以上）或急迫性尿失禁（突然不自主漏尿）等現象，雖不會致命，卻會嚴重影響日常生活。然而，儘管隨著診斷工具的日新月異伴隨病患自我意識的提升，膀胱過動症逐漸為大家所熟悉且為泌尿科重視的課題，然而對於其合併伴隨的系統性症狀包括其他非泌尿系統的症狀，一直沒有詳細的研究。 本文為美國進行自2012年至2014年前瞻性收案的研究，透過各個不同的問卷來檢視並比較膀胱過動症病人與非膀胱過動症病人的差異，使用以評估受試者的工具包括有非泌尿系統性症狀的問卷(PSPS-Q問卷)、膀胱過動症評估的各種問卷(包括ICIQ-UI, ICIQ-OAB, OAB-q簡單版本, UDI-6, IIQ-7, USS等)、心理狀態評估問卷(包括評估憂鬱症的問卷HADS-D、心理壓力狀態評估問卷PSS、兒童時期心理創傷評估問卷CTES、用以評估睡眠狀態的問卷PROMIS-Sleep、及評估疲憊感受程度的問卷PROMIS-Fatigue)。該研究結果發現，膀胱過動症的病人在非泌尿系統的症狀，包括神經、腸胃、性功能、肌肉性、婦女系統性的症狀，無論在症狀的表現頻率與嚴重程度，均較非膀胱過動症的病人要來的多上許多，且達到統計學上的差異(上述各項比較之P值均小於0.05)；然而，在心理層面的症狀在兩組病人的比較卻沒有達到差異。十大常見的主訴症狀包括：憂鬱情緒、背痛、頭痛、關節痛、便祕、疲憊、腹瀉、脹氣、腹痛、麻木刺痛感感等。大約三分之一的膀胱過動症病人(31.4%)有多個不同系統的症狀主訴，此分佈遠較非膀胱過動症病人要來的高(6.7%)。進一步的族群分系更發現到此具有多系統症狀的膀胱過動症病人，相較於沒有多系統性症狀表現的膀胱過動症病人，其膀胱過動症的控制更差且生活品質也較為低下(各項比較P值均小於0.05，且已經透過年齡及性別調整進行比較)。 此項研究讓我們得知膀胱過動症的病患可能存在的問題並非單純為單一系統性的問題，而是否膀胱過動症本身其實機轉和一全身系統系的機轉有關係(包括可能是血清素serotonin分泌受到影響造成全身症狀之機轉，或存在骨盆腔的神經問題影響到包括腸道與泌尿系統性症狀)，抑或膀胱過動症於另一層面為存在全身性病因造成的。此研究讓我們值得思考的另一個層面是當我們在面對膀胱過動症的患者時，其實不能僅面對泌尿系統性症狀，而是更要以「全人」的角度來面對病人，並省視其各種不同面向症狀的問題，如此才能夠協助病人改善其生活品質與各種症狀。 |
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| abstract |
Purpose: We compare the systemic (nonurological) symptoms between patients with overactive bladder and subjects without overactive bladder. We also compare the urinary symptoms, quality of life and psychosocial measures between the 2 subgroups of patients with overactive bladder with a high vs low systemic symptom burden. Materials and Methods: Patients diagnosed with overactive bladder (51) and age matched individuals without overactive bladder (30) were administered the polysymptomatic, polysyndromic questionnaire to assess the numbers and distribution of systemic symptoms across multiple organ systems. Validated instruments were administered to evaluate urinary symptoms (ICIQ-UI, ICIQOAB, OAB-q, USS), quality of life (UDI-6, IIQ-7, OAB-q) and psychosocial difficulties (depression, anxiety, stress, sexual trauma, sleep, fatigue). Patients with overactive bladder were divided into 2 subgroups (with and without widespread systemic symptoms) and their responses were compared. Results: Patients with overactive bladder reported significantly more systemic (nonurological) symptoms compared to controls (mean ± SD 17.5 ± 12.3 vs 6.4 ± 7.9 symptoms, p <0.001). Differences were observed across multiple organ systems (neurologic, cardiopulmonary, gastrointestinal, sexual, musculoskeletal and gynecologic, p <0.05). About a third of patients with overactive bladder (31.4%) reported widespread systemic symptoms across multiple organ systems (mean 32.0 symptoms). The presence of widespread systemic symptoms among patients with overactive bladder was correlated with worse incontinence/overactive bladder symptoms (ICIQ-UI, OAB-q), poorer quality of life (UDI-6, IIQ-7, OAB-q) and more psychosocial difficulties (depression, anxiety, fatigue, and higher stress, p <0.05). Conclusions: The increased presence of nonurological symptoms in overactive bladder suggests an underlying systemic etiology and pathogenetic mechanisms that may contribute to overactive bladder. This study highlights the importance of understanding systemic factors in urological conditions otherwise thought to be organ specific. |
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