Weiss Jeffrey P, Blaivas Jerry G, Jones Mark, Wang Joseph T, Guan Zhonghong
Weill Cornell Medical Center, New York, New York 10021, USA.
J Urol. 2007 Aug;178(2):548-51; discussion 551. doi: 10.1016/j.juro.2007.03.117. Epub 2007 Jun 14.
Nocturia is caused by increased nocturnal urine output (nocturnal polyuria) and/or diminished nocturnal bladder capacity. We retrospectively evaluated the causes of nocturia in patients with overactive bladder and nocturia.
A total of 850 patients (18 years or older) with symptoms of overactive bladder (8 or more micturitions per 24 hours and urgency or urgency urinary incontinence) and nocturia (mean of 2.5 or more episodes per night) were enrolled in a 12-week study of tolterodine ER (4 mg QD) vs placebo. Of this total 845 patients (417 men and 428 women) completed 7-day bladder diaries. Patients were stratified post hoc by sex and age groups (less than 50, 50 to 70, more than 70 years). Indices of nocturnal urine production (nocturia index, nocturnal polyuria index and nocturnal bladder capacity index) were compared using ANOVA (alpha level 0.05). Higher nocturia index and nocturnal polyuria index values suggest that nocturia occurs because of nocturnal urine overproduction. Higher nocturnal bladder capacity index values suggest that nocturia occurs because of decreased nocturnal bladder capacity.
There were no statistically significant gender or age related differences in baseline nocturnal micturitions. Nocturia index increased significantly with age (p <0.0001), and values were significantly higher among men than women for all age groups (p = 0.0064). Nocturnal polyuria index increased significantly with age (p <0.0001) and there were no gender differences. For nocturnal bladder capacity index there was a significant decrease with advancing age among men (1.75 greater than 1.16 greater than 0.90) and women (1.53 greater than 1.42 greater than 1.08, P(interaction) = 0.0148).
In younger patients with overactive bladder, decreased nocturnal bladder capacity has a greater role in the pathogenesis of nocturia symptoms, whereas in older patients increased nocturnal urine output has a greater role.
夜尿症是由夜间尿量增加（夜间多尿）和/或夜间膀胱容量减小引起的。我们回顾性评估了膀胱过度活动症合并夜尿症患者夜尿症的病因。
共有850例年龄在18岁及以上、有膀胱过度活动症症状（每24小时排尿8次或更多，伴有尿急或急迫性尿失禁）和夜尿症（平均每晚发作2.5次或更多）的患者参加了一项为期12周的托特罗定缓释片（4毫克，每日一次）与安慰剂对比研究。这850例患者中，845例（417例男性和428例女性）完成了7天的膀胱日记。患者事后按性别和年龄组（小于50岁、50至70岁、大于70岁）进行分层。使用方差分析（α水平0.05）比较夜间尿量指标（夜尿指数、夜间多尿指数和夜间膀胱容量指数）。较高的夜尿指数和夜间多尿指数值表明夜尿症是由于夜间尿量过多所致。较高的夜间膀胱容量指数值表明夜尿症是由于夜间膀胱容量减小所致。
基线夜间排尿次数在性别或年龄方面无统计学显著差异。夜尿指数随年龄显著增加（p<0.0001），且在所有年龄组中男性的值均显著高于女性（p = 0.0064）。夜间多尿指数随年龄显著增加（p<0.0001），且无性别差异。对于夜间膀胱容量指数，男性（1.75>1.16>0.90）和女性（1.53>1.42>1.08，P（交互作用）= 0.0148）均随年龄增长显著降低。
在年轻的膀胱过度活动症患者中，夜间膀胱容量减小在夜尿症症状的发病机制中起更大作用，而在老年患者中，夜间尿量增加起更大作用。
