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| 發表人 | 討論主題 | 發表時間 | 討論數 |
| 劉緯陽醫師 | 減重與治療過度肥胖婦女的尿失禁 | 2009/5/31 下午 01:13:20 | 0 |
| 原 文 | 題 目 | Weight Loss to Treat Urinary Incontinence in Overweight and Obese Women |
| 作 者 | Leslee L. Subak, M.D., Rena Wing, Ph.D., Delia Smith West, Ph.D., Frank Franklin, M.D., Ph.D., Eric Vittinghoff, Ph.D. | |
| 出 處 | N Engl J Med | |
| 出版日期 | Volume 360: 481-490 January 29, 2009 | |
| 評 論 |
眾所周知肥胖是造成尿失禁的危險因子之一，且也是少數中可以矯正的因素，但是臨床上有關减重對尿失禁治療好處仍缺乏有力且可信的証據。這篇眾所矚目的文章發表於一月份新英格蘭醫學雜誌，主要是藉由隨機分配的方法來瞭解減重是否能治療肥胖婦女尿失禁。 實驗設計上總共包括了338位過度肥胖婦女，平均年齡為53 ± 11歲，每位患者每星期至少有10次以上的尿失禁。參加者皆隨意地(randomly)被分配到二組，其中研究組(共226人)要持續參加六個月密集的减重方案包括飲食、運動和行為矯正；而另一控制組(共112人)僅上過有系統的减重教育課。兩個隨機研究樣本於基礎上不論是BMI值及每週尿失禁次數上皆相同。 研究結果顯示於參與密集减重方案的研究組平均减重是8.0% (約7.8 kg)相較於控制組約減重1.6% (約1.5 kg) (P < 0.001)。在6個月以後，每週尿失禁次數於參與密集减重方案的研究組平均約減少47%相較於控制組約28% (P = 0.01)。參與密集减重方案的研究組相較於控制組主要是在應力性尿失禁次數上有大幅減少 (P = 0.02)，但是在急迫性尿失禁上則無差異(P = 0.14)。更進一步分析發現參與密集减重方案患者中相較於控制組會有較高的比率總尿失禁次數減少70%以上(P<0.001)，應力性尿失禁(P=0.009)，急迫性尿失禁(P=0.04)。 文章總結主要是告訴大家與控制群相比較，參與密集减重六個月的過度肥胖婦女於減重目標達到時也會減少失禁次數;本文作者自己寫道〝適度減重會帶來許多健康上助益而改善尿失禁可能是其中之一的好處。〞 雖然本研究於設計上缺乏雙盲設計，但仍具有臨床參考價值，讓大家對肥胖婦女尿失禁治療上多一份有力證據來說明減重的多方益處。未來也希望學會能推動臺灣本土的研究來更進一步探討肥胖與尿失禁、膀胱過動等相關問題。 |
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| abstract |
Background Obesity is an established and modifiable risk factor for urinary incontinence, but conclusive evidence for a beneficial effect of weight loss on urinary incontinence is lacking. Methods We randomly assigned 338 overweight and obese women with at least 10 urinary-incontinence episodes per week to an intensive 6-month weight-loss program that included diet, exercise, and behavior modification (226 patients) or to a structured education program (112 patients). Results The mean (±SD) age of the participants was 53±11 years. The body-mass index (BMI) (the weight in kilograms divided by the square of the height in meters) and the weekly number of incontinence episodes as recorded in a 7-day diary of voiding were similar in the intervention group and the control group at baseline (BMI, 36±6 and 36±5, respectively; incontinence episodes, 24±18 and 24±16, respectively). The women in the intervention group had a mean weight loss of 8.0% (7.8 kg), as compared with 1.6% (1.5 kg) in the control group (P<0.001). After 6 months, the mean weekly number of incontinence episodes decreased by 47% in the intervention group, as compared with 28% in the control group (P=0.01). As compared with the control group, the intervention group had a greater decrease in the frequency of stress-incontinence episodes (P=0.02), but not of urge-incontinence episodes (P=0.14). A higher proportion of the intervention group than of the control group had a clinically relevant reduction of 70% or more in the frequency of all incontinence episodes (P<0.001), stress-incontinence episodes (P=0.009), and urge-incontinence episodes (P=0.04). Conclusions A 6-month behavioral intervention targeting weight loss reduced the frequency of self-reported urinary-incontinence episodes among overweight and obese women as compared with a control group. A decrease in urinary incontinence may be another benefit among the extensive health improvements associated with moderate weight reduction |
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