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.

Urodynamic findings and pathological alterations in diabetic cystopathy

Objective:To observe the abnormalities of urodynamics and pathology in diabetic cystopathy(DCP).Methods:Diabetes Mellitus(DM) models were made in 30 wistar rats and 30 normal rats were used as control.The bladder storage pressure,the bladder maximum capacity,the maximum bladder pressure and bladder compliance were evaluated.The bladder weight and bladder wall thickness were measured and the histopathologic structure of bladder wall was observed by optical and electric microscopy.System Urodynamics study were carried out in 32 cases of early stage DM patients,28 cases of advanced stage DM patients and 22 healthy people.Results:The maximum bladder capacity,bladder weight(P<(0.01)),compliance(P<(0.05)) and resting pressure(P<(0.01)) in DM rats were found significantly higer that those of control.However,the maximum bladder pressure significantly decreased comparing with that of the control group(P<(0.01)).In the DM rats,not only the total bladder wall thickness is greater but also the muscle bundles appear to be increased in size.The detrusor cell in DM rats showed obvious karyopyknosis,cell junction fibrosis,fibroblast degeneration and collagen fibers array disorder.The early stage DM patients had lower UFR(P<(0.05)).59% cases had detrusor contraction hyperfunction and(37.5)% cases had detrusor/sphincter dyssynergia.In later stage DM patients,decreased UFR(P<(0.01)),elevated bladder volume,increasedg residual urine volume and weaken detrusor contractility were noted.Conclusions:In DM patients of the early stage,the urodynamics and histopathology have showed difference compared to the normal bladders.It is suggested that the bladder function is impaired obviously.The result of this study is informative in understanding patient progress and therapeutic result.