Castro Neviton M, Freitas Daniel M, Rodrigues Waldyr, Muniz Andre, Oliveira Paulo, Carvalho Edgar M
Section of Immunology, University Hospital, Bahia Federal University, Salvador, Bahia, Brazil.
Int Braz J Urol. 2007 Mar-Apr;33(2):238-44; discussion 244-5. doi: 10.1590/s1677-55382007000200016.
To describe urodynamic abnormalities in HTLV-1 infected individuals presenting urinary symptoms and verify if these findings and quality of life (QOL) evaluation correlate with overall neurological impairment.
From January/2001 to May/2004, 324 HTLV-1 seropositive subjects were evaluated to determine the occurrence of urinary symptoms. Urodynamic testing was performed in those who complained of frequency, urgency, or incontinence. They went through a complete clinical, neurological, and urological examination to investigate symptoms and signs of myelopathy. Neurological disability was assessed by Expanded Disability Status Scale (EDSS).
From the 324 patients evaluated, 78 underwent the urodynamic testing. Fifty-seven individuals were females (73.1%) and age ranged from 23 to 76 years (mean=48.7 years; SD +/- 11.6). Urodynamic testing was abnormal in 63 patients (80.8%). The major abnormality was detrusor overactivity (DO), observed in 33 individuals (33/63; 52.4%), followed by detrusor-external sphincter dyssynergia (DESD), diagnosed in 15 subjects (15/63; 25.4%). HAM/TSP patients had significantly more DESD than the HTLV-I carriers (p=0.005; OR=5.5; CI: 1.6 to 19.4). QOL was severely compromised in HAM/TSP patients.
Prominent urodynamic abnormalities were identified in individuals genuinely considered as HTLV-I carriers, suggesting an early compromise of the urinary tract; whereas HAM/TSP patients presented urodynamic findings, which posed a potential risk to the upper urinary tract (dyssynergia). Urodynamic evaluation should be performed in all HTLV-I-infected individuals with voiding complaints.
描述出现泌尿症状的人类嗜T淋巴细胞病毒1型（HTLV-1）感染个体的尿动力学异常情况，并验证这些发现及生活质量（QOL）评估是否与整体神经功能损害相关。
2001年1月至2004年5月，对324名HTLV-1血清学阳性受试者进行评估以确定泌尿症状的发生情况。对那些主诉尿频、尿急或尿失禁的患者进行尿动力学检测。他们接受了全面的临床、神经和泌尿外科检查，以调查脊髓病的症状和体征。通过扩展残疾状态量表（EDSS）评估神经功能障碍。
在接受评估的324例患者中，78例进行了尿动力学检测。57例为女性（73.1%），年龄在23至76岁之间（平均=48.7岁；标准差±11.6）。63例患者（80.8%）尿动力学检测异常。主要异常为逼尿肌过度活动（DO），在33例个体中观察到（33/63；52.4%），其次是逼尿肌-外括约肌协同失调（DESD），在15例受试者中诊断出（15/63；25.4%）。热带痉挛性截瘫（HAM/TSP）患者的DESD明显多于HTLV-I携带者（p=0.005；比值比=5.5；可信区间：1.6至19.4）。HAM/TSP患者的生活质量严重受损。
在真正被视为HTLV-I携带者的个体中发现了明显的尿动力学异常，提示尿路早期受损；而HAM/TSP患者的尿动力学表现对上尿路构成潜在风险（协同失调）。所有有排尿主诉的HTLV-I感染个体均应进行尿动力学评估。
