糖尿病患者膀胱功能改变的临床研究

目的 :探讨糖尿病患者膀胱功能变化及其机制。方法 :将 70例糖尿病患者按照病程分为早期组和进展期组 ,分别对其初尿意的膀胱容量、最大膀胱容量、最大自由尿流率、最大尿流时的逼尿肌压力 (PQmax)、剩余尿量进行分析。结果 :早期组糖尿病患者产生初尿意的膀胱容量增大至 (15 1.6 7± 2 4 .0 7)ml,进展期糖尿病患者初尿意的膀胱容量进一步增大至 (2 6 8.16± 13.90 )ml,最大膀胱容量增大至 (5 92 .97± 2 5 2 .5 1)ml,最大自由尿流率降低至 (8.6 1± 2 .0 4 )ml/min ,PQmax降低 (3.2 5± 1.94 )kPa ,剩余尿量增加至 (16 9.0 3± 137.2 5 )ml。结论 :早期糖尿病患者膀胱感觉减退可能是逼尿肌兴奋性降低的缘故 ;进展期糖尿病患者的一系列尿动力学改变 ,可能是在逼尿肌兴奋性改变的基础上出现逼尿肌收缩力降低的结果。     

糖尿病膀胱尿动力学及逼尿肌功能改变的相关性研究

目的探讨糖尿病膀胱尿动力学变化与逼尿肌功能改变之间的相关性。方法回顾性分析70例糖尿病患者尿动力学检查结果,将患者分为早期组(病史<8年〉和进展期组(病史>12年),分别测定初尿意的膀胱容量、最大膀胱容量、最大自由尿流率、PQmax、剩余尿量。并结合2型糖尿病(T2DM)大鼠与正常大鼠的离体逼尿肌肌条实验,分析实验鼠发病6周和18周的逼尿肌兴奋性、最大收缩力和平均收缩力变化。结果临床资料显示29例(41%)表现为低顺应性膀胱,28例(40%)膀胱感觉减退,30例(43%)排尿期逼尿肌压力减退,22例(31%)剩余尿量超过150ml,10例(14%)逼尿肌不稳定,6例(9%)不能自行排尿。患者膀胱灌注过程中产生初尿意的灌注容量(203.25±107.53)ml(125~630ml),最大膀胱容量(428.09±227.89)ml(220~1350ml)。最大自由尿流率(10.70±3.27)ml/min,剩余尿量(100.57±108.08)ml,早期组患者产生初尿意的膀胱容量增加为(151.67±24.07)ml,进展期患者初尿意的膀胱容量增加为(268.16±13.90)ml,最大膀胱容量(592.97±252.51)ml,最大自由尿流率(8.61±2.04)ml/min,PQmax(33.16±19.81)cmH2O(1cmH2O=0.098kPa),剩余尿增加至(169.03±137.25)ml。动物实验发现T2DM大鼠逼尿肌的张力阈值为(0.72±0.33)g,显著高于对照组(0.32±0.18)g,F=59.63,P<0.0001;最大逼尿肌收缩力T2DM组(0.08±0.04)g,较对照组(0.11±0.05)g降低(F=7.47,P<0.01);平均收缩力T2DM组(0.06±0.02)g,较对照组(0.07±0.03)g明显降低(F=5.71,P<0.05)。随着实验动物发病时间延长,T2DM大鼠逼尿肌张力阈值呈现增高趋势,而逼尿肌最大及平均收缩力均降低。结论根据临床及动物实验结果推测,早期糖尿病患者膀胱感觉减退可能是逼尿肌兴奋性降低的缘故。进展期膀胱感觉进一步减退、最大膀胱容量显著增大、最大自由尿流率降低、排尿期最大尿流时的逼尿肌压力降低、剩余尿量显著增多等一系列尿动力学改变,可能是在逼尿肌兴奋性改变的基础上出现逼尿肌收缩力降低的结果。     

犬神经原性膀胱模型的建立及尿动力学评价

目的　建立犬神经原性膀胱模型 ,进行尿动力学评价。　方法　 8只雌性杂交犬 ,骶上组 4只在第 5～ 6腰椎间孔水平横断脊髓 ,骶下组 4只在此基础上完全破坏骶髓。尿动力学测定模型犬术前及术后 6个月的膀胱容量、逼尿肌压力、膀胱顺应性、尿道压力。　结果　模型犬术后一直存在尾部不能活动和不同程度湿臀的现象 ;弛缓性瘫痪的后肢术后 1周起逐渐恢复 ;下腹部膨胀症状的改善仅见于骶上型犬。骶上组犬术后膀胱容量、顺应性分别下降 37.3%、5 2 .1% ,逼尿肌压力、尿道压力分别增加 33.3%、17.3% ,与术前相比差异均有显著性意义 (P <0 .0 5 ) ;骶下组犬的膀胱容量、顺应性分别上升 89.5 %、78.8% ,与术前和骶上组相比差异均有显著性意义 (P <0 .0 5 )。　结论　在症状及尿动力学方面 ,术后 6个月的犬骶上型和骶下型神经原性膀胱模型均符合脊髓损伤恢复期的膀胱表现 ,两模型适于进行神经原性膀胱的研究。     

糖尿病膀胱的尿动力学及病理学改变(附动物实验与临床观察)

目的:观察糖尿病膀胱(DCP)的尿动力学及病理学改变,探讨发病机制及病理演绎过程.方法:建立DCP wistar大鼠模型(30只),正常wistar大鼠作对照(30只),进行膀胱储尿期压、最大容量、最大膀胱压等测定,进行膀胱湿重、膀胱壁厚度及光镜、电镜的病理学观察.早期DCP患者(32例),晚期DCP(28例)及非DM人群(22例)进行尿流率、压力-流率尿道分布压及括约肌肌电图等测定,作相关统计学处理.结果:①60天后,DCP鼠组与对照组:膀胱储尿期压(0.45±0.08)kPa,(0.60±0.03)kPa(P＜0.05);最大膀胱容量(3.49±0.40)ml,(1.82±0.12)ml(P＜0.01);最大膀胱压(3.09±0.10)kPa,(4.91±0.30)kPa(P＜0.01);膀胱顺应性(1.39±0.11)ml·kPa-1,(0.68±0.07)ml·kPa-1(P ＜0.01);湿重增加(P ＜0.01);逼尿肌细胞连接纤维化,成纤维细胞变性及胶原纤维排列紊乱.②相对于对照组,早期DCP患者最大尿流率偏低,为(15.97±5.71)ml·s(P ＜0.05),逼尿肌活动亢进(占59%),逼尿肌/括约肌协同失调(占37.5%);而晚期DCP患者最大尿流率明显下降,为(8.75±4.20)ml·s-1(P ＜0.01),膀胱容量增加,为(472.5±32.9)ml(P ＜0.01),剩余尿量增多,为(62.59±19.87)ml(P ＜0.01),逼尿肌收缩功能减弱.结论:DCP早期就有膀胱的动力学及病理学改变,以逼尿肌活动功能亢进,逼尿肌/括约肌协同失调较常见,晚期以逼尿肌收缩功能减弱为主,建议对DCP患者早期就应给予干预,控制病情的进一步恶化.     

糖尿病性膀胱功能损害的尿动力学分析

目的：探讨尿动力学检查在糖尿病性膀胱功能损害诊断中的意义。方法：对糖尿病患者做全面的尿动力学检测并分析各项参数；再按糖尿病病程及血糖控制情况分组进行对比分析。结果：70例中逼尿肌收缩功能正常18例（25．7％）；逼尿肌功能受损38例（54．3％）；反射亢进14例（20％）。病程〉3年的48例中，逼尿肌收缩功能受损者29例（60．4％）。病程〈3年的22例中，逼尿肌收缩功能受损者9例（40．9％）。血糖控制稳定的25例中，逼尿肌收缩功能受损者7例（28％）；不稳定的45例中，逼尿肌收缩功能受损者31例（68．9％）。结论：糖尿病性膀胱功能损害表现呈多样性，血糖水平与膀胱功能损害有相关性；尿动力学检测对预防和治疗糖尿病性膀胱功能损害有重要的指导意义。     

女性糖尿病患者膀胱功能障碍的尿动力学研究

目的：探讨尿动力学检查在糖尿病患者膀胱功能障碍诊断中的意义。方法：回顾性分析32例女性糖尿病膀胱病变患者的临床资料和尿动力学检查结果,明确尿动力学的特征性改变。结果：早期组最大尿流率、膀胱容量下降,逼尿肌压力增加,初始尿意、剩余尿量正常;晚期组最大尿流率、逼尿肌压力下降明显,初始尿意、剩余尿、膀胱容量显著增加。结论：女性伴有下尿路症状（LUTS）的糖尿病患者膀胱功能异常的发生率高,随着病程延长,膀胱功能改变明显。尿动力学检查可以明确膀胱功能,对合并糖尿病的LUTS患者的正确诊断和治疗具有重要的指导意义。     

糖尿病性膀胱IPSS及影像或普通尿动力学研究

目的：评价糖尿病患者排尿异常与副尿肌行为间的关系。方法：对44例糖尿病患者进行影像或普通尿动力学检查及IPSS评价。将糖尿病性膀胱划分为逼尿肌受损型和感觉受损型。结果：17例糖尿病患者诊断为糖尿病性膀胱，27例糖尿病患者尿动力学结果正常。糖尿病性膀胱患者与尿动力学检查正常的糖尿病患者相比，尿流率中大多数参数差异具有显著性意义；主观症状评分梗阻指数显著性增高，但刺激症状指数差异无显著性意义。结论：梗阻指数升高而刺激指数无显著性升高可能是糖尿病性膀胱尿动力学的特征性改变。尽管尿流率和IPSS评价不能特异性区分逼尿肌受损情况，但为进一步进行尿动力学检查提供了有益的参考。     

尿动力学检查在糖尿病患者膀胱功能评定中的意义

目的探讨尿动力学检查在糖尿病患者膀胱功能障碍诊断中的意义。方法伴有下尿路症状(LUTS)的糖尿病患者42例，年龄38～78岁，男24例，女18例。糖尿病发病1个月一25年。结果42例患者完成尿动力学全项检查41例，尿动力学表现异常者38例(93％)，尿动力学表现正常3例(7％)；膀胱逼尿肌收缩减低14例(34％)；膀胱逼尿肌反射消失10例(24％)；膀胱出口梗阻13例(32％，13／41)；女性压力性尿失禁1例。结论伴有LUTS的糖尿病患者膀胱功能异常发生率高，尿动力学检查可以明确膀胱逼尿肌功能，对合并糖尿病的LUTS患者正确诊断和治疗具有重要意义．糖尿病患者行膀胱尿道手术前进行尿动力学检查可提高手术成功率。     

糖尿病膀胱病变的病因学研究进展

糖尿病膀胱病变（diabetic cystopathy，DCP），是糖尿病引起的泌尿系统并发症之一。因其可诱发尿潴留、尿路感染甚至肾功能衰竭，严重影响患者生活质量，近年来日益受到国内外临床医师及相关科研人员的重视。本文综述了近几年来国内外有关DCP的研究进展。     

豚鼠逼尿肌不稳定模型的建立与评估方法的改进

目的寻找一种简单、可靠的方法建立并评估豚鼠膀胱逼尿肌不稳定模型。方法成年雌性豚鼠经会阴部尿道结扎，6周后行膀胱穿刺充盈性膀胱测压，观察膀胱压力、容量变化及逼尿肌不稳定的发生情况。结果实验组逼尿肌不稳定发生率35．9％，对照组无发生，其中逼尿肌不稳定膀胱组膀胱最大压力和最大容量较对照组显著增加（P〈0．01）。结论经会阴部尿道结扎、膀胱穿刺充盈性膀胱测压是建立及评估豚鼠膀胱出口梗阻引起逼尿肌不稳定模型的一种简单、可靠的方法。     

内皮型一氧化氮合酶在大鼠糖尿病膀胱病变中的作用

目的 探讨大鼠糖尿病膀胱病变组织中内皮型一氧化氮合酶(eNOS)的表达及意义.方法 雄性SD大鼠36只.随机分为正常组、多尿组和糖尿病组,每组12只.采用尿动力学方法对大鼠膀胱容量、单次排尿量、膀胱内最大压力、残尿壁和排尿率等指标进行评价,应用RT-PCR和蛋白质印迹方法检测大鼠膀胱组织中eNOS mRNA和蛋白质的表达水平,统计学分析其与膀胱功能的相关性.结果 6周时正常组大鼠最大膀胱容量、单次排尿量、残余尿量分别为(0.75±0.04)、(0.70±0.02)和(0.06±0.00)ml,多尿组分别为(1.62±0.15)、(1.52±0.30)和(0.11±0.01)ml,糖尿病组分别为(2.29±0.16)、(2.06±0.25)和(0.23±0.01)ml,与正常组和多尿组相比,差异具有统计学意义(P＜0.01);12周时正常组上述指标分别为(0.86±0.06)、(0.80±0.04)和(0.07±0.00)ml,多尿组分别为(1.93±0.10)、(1.77±0.11)和(0.13±0.02)ml,糖尿病组分别为(2.65±0.26)、(2.09±0.21)和(0.56±0.06)ml,各组间差异具有统计学意义(P＜0.01).糖尿病组与6周时相比,各指标增加,其中残余尿量差异具有统计学意义(P＜0.01).6周时3组排尿率分别为(93.3±2.1)%、(93.2±2.7)%和(90.0±2.5)%,组间差异无统计学意义(P＞0.05);12周时分别为(93.1±2.2)%、(93.8±3.2)%和(78.1±2.6)%,糖尿病组小于其他2组(P＜0.05).各组膀胱内压力差异无统计学意义.糖尿病组膀胱压力曲线出现压力小波动,曲线不规则.6周时各组膀胱组织中eNOSmRNA表达相对灰度值分别为0.81±0.12、0.90±0.12和1.98±0.16,糖尿病组高于其他2组,差异具有统计学意义(P＜0.01);12周时为0.87±0.17、1.05±0.11和2.89±0.23,糖尿病组与6周时相比增加(P＜0.01).6周时各组eNOS蛋白表达相对灰度值分别为0.98±0.12、0.93±0.14和2.28±0.16,糖尿病组高于其他2组(P＜0.01);12周时为1.03±0.13、1.14±0.11和3.12±0.20,糖尿病组与6周时相比增加(P＜0.01).糖尿病组大鼠膀胱eNOS蛋白表达强度与排尿率旱负相关(r=-0.669,P＜0.01).结论 膀胱组织中eNOS mRNA和蛋白表达上调可能参与了糖尿病膀胱病变的发生发展.     

A combined urodynamic and electrophysiological study of diabetic cystopathy

AIMS: The aim of this study is to compare urodynamics and electrophysiological studies in the diagnosis of diabetic cystopathy. MATERIALS AND METHODS: In this prospective study are included twenty six patients with diabetes mellitus diagnosed at least since 5 years; 17 patients with diabetes type II and 9 with type I. They were divided in two groups in respect to lower urinary tract symptoms (LUTS) and signs suggestive of lower urinary tract dysfunction (LUTD) according to the ICS standardization. Patients with LUTS/LUTD were included in Group A and patients without LUTS/LUTD in Group B. Patients underwent different studies: urodynamic, somatosensory evoked potentials (SSEP) of tibial and pudendal nerves, bulbocavernosus reflex (BCR), bulbocavernosus muscles' electromyography and motor evoked potentials after transcranial magnetic stimulation to indirectly investigate bladder's innervation. RESULTS: Abnormal urodynamics were found in 13 patients of group A (92.9%) and in 5 of group B (47.1%). This difference was statistically significant (P=0.009). Abnormally prolonged latency of P40 of tibial SSEP was found in 11 patients of group A (78.6%) and in 4 of group B (33.3%) and this difference was also statistically significant (P=0.04). Differences between the two groups concerning: i) peripheral polyneuropathy; ii) pudendal SSEP, iii) dysfunction of central nervous system and iv) abnormal BCR were not statistically significant. CONCLUSION: The study of tibial SSEP is an easily performed test and it is well correlated to abnormal urodynamics in diabetic patients with and without LUTD/LUTS.     

Contractility of the guinea pig bladder measured in situ and in vitro

To study the relative importance of neurogenic factors in detrusor contractility and to relate a total bladder in vitro contractility model to a previously described bladder wall strip model, active intravesical pressure values were compared in situ and in vitro in eight male guinea pigs. In situ, the active pressure was measured in spontaneous isometric and nonisometric micturition contractions. In vitro, the active pressure was measured in isometric contractions of the same bladders, developed in response to optimal electrical stimulation. The volume dependence of the active pressure generated by the bladder was measured in vitro in order to relate bladder capacity to the volume where the generated force is maximal and to determine the optimal volume at which to study detrusor contractility. The results indicated that in normal micturition the detrusor muscle was not fully stimulated: active pressure in isometric contractions in vivo was about 60% of the pressure values attained in vitro at the same bladder volume. Most micturitions occurred at a volume where the active pressure generated in vitro was about 80% of the maximal pressure. The active pressure-bladder volume relationship complied with the sliding filament-cross bridge theory. In whole bladder preparations active stress was about twice as high as in strips. © 1994 Wiley-Liss, Inc.     

Bladder dysfunction in type 2 diabetic patients

AIMS: To reevaluate urodynamic findings of bladder dysfunction (BD) in type 2 diabetic patients with patient characteristics and concommittant chronic complications. METHODS: Patients (M/F:27/27) with lower urinary tract symptoms (LUTS) underwent a detailed urodynamic investigation. Urodynamic findings were classified as diabetic cystopathy [DC, characterized by impaired bladder sensation, increased post-void residual urine (PVR) and increased bladder capacity and decreased bladder contractility], detrusor overactivity, bladder outlet obstruction (BOO), urge and stress urinary incontinence or BD in which one of the alterations was included. Glycated hemoglobin (HbA1C), diabetic retinopathy, nephropathy, sensorimotor, and autonomic neuropathies were evaluated. RESULTS: BD was present in 74.07% of men (DC, 50%; BOO, 25%; detrusor overactivity, 25%) and in 59.26% of diabetic women (DC, 43.75%; detrusor overactivity, 31%; urge incontinence, 12.5%; stress urinary incontinence 12.5%). In men, age, duration of diabetes and HbA1C threshold values predicting BD were >64 years, >9 year, >7.9%, while in women, they were >56 years, >8 years, >7%, respectively. Prolongation of QTc, abnormal esophageal transit and gastric emptying times, diabetic retinopathy, and microalbuminuria were associated with an increased risk of PVR >or= 100 ml. CONCLUSIONS: DC was the most frequent finding in patients. Ageing, duration of diabetes, worse metabolic control, PVR 100 ml, cardiac, esophageal and gastric parasympathetic autonomic neuropathies, retinopathy, and microalbuminuria provided a means to predict BD in patients in order to investigate by urodynamics. The establishment of DC in at least 8-9 years after the diagnosis of type 2 DM was an important parameter to inform our diabetic patients.     

Suture causing urethral meatus stricture: A novel animal model of partial bladder outlet obstruction

Aims

Open surgery is the most commonly used methodological approach for generating a partial bladder outlet obstruction (pBOO) animal model. Surgical suturing closing a part of the urethral meatus induces comparable pathophysiological changes in bladder and renal functions, but the optimum degree of obstruction that closely mimics the clinical pathology of pBOO has not been elucidated. We investigated the optimum obstruction level by performing a comprehensive time‐dependent analysis of the stability and reliability of this novel animal model.

Methods

Six‐ to eight‐week‐old female BALB/c mice were divided into three groups according to the degree of urethral meatus stricture (UMS). Non‐operated mice served as controls, and a pBOO model generated using the traditional method served as a positive control. A cystometric evaluation and long‐term studies were performed to evaluate the validity and reliability of this novel animal model. An additional 35 mice were used to investigate the protein expression levels and histopathological features 24 h and 14 days postoperatively, respectively.

Results

The characteristic cystometry features in the UMS group revealed increased changes in pressure‐related parameters compared with the control. The 1/3 UMS model is an optional pBOO animal model because the cystometric evaluation and histopathological studies revealed a striking resemblance between the 1/3 UMS model and the model generated using the traditional open‐surgery method.

Conclusions

The minimally invasive UMS model required less time and produced minimal alterations in pathophysiologically relevant processes compared with the traditional surgery model. Suturing to cause UMS produced effective and repeatable patterns in bladder function investigations in mice.     

小型猪原位肝移植模型的建立与评价

目的 探讨建立放弃静脉转流的小型猪原位肝移植模型的可行性。方法 选用广西巴马小型猪(3-6月龄,8-11kg)为实验动物,共实施原位肝移植10例次。供体肝脏游离、冷灌注、切取、修整以及UW保存按常规方法进行。受体术中肝脏游离后夹闭肝上、肝下下腔静脉和门静脉并切除受体肝脏,各血管断端与供肝相应血管进行端端吻合,肝上下腔静脉和门静脉吻合完毕即开放肝脏血流,在此过程中未使用静脉转流,此后吻合肝动脉、胆管。结果 本组10例次肝移植手术后一周存活率90％(9/10),无肝期时间31.3±2.67min,无肝期血压显著下降(MAP4.5±1.58kPa)但肝血流开放后能较快恢复并渐趋平稳。结论 本组结果表明,非静脉转流条件下的小型猪肝移植模型是一操作方便、易于复制同时又具有较好重复性和稳定性的大动物肝移植模型,能应用于肝移植的系列实验研究。