Department of Urology, China Rehabilitation Research Center, Beijing, China.
Spinal Cord. 2013 Jun;51(6):487-90. doi: 10.1038/sc.2012.180. Epub 2013 Jan 29.
The study was designed as a single-arm clinical trial.
To investigate the effect of detrusor botulinum toxin A (BoNTA) injection on urinary tract infection (UTI) in patients with spinal cord injury (SCI).
The study was performed in a national rehabilitation research center of China.
Between September 2010 and May 2012, 41 male inpatients with neurogenic detrusor overactivity (NDO) caused by traumatic SCI, mean age 36.0±8.8 years, duration of SCI since inclusion 21.5±17.3 months, received an injection of 300 U BoNTA into detrusor. Before and 3 months after injection, each patient kept a bladder diary, underwent video-urodynamic investigation and urine culture. All UTIs occurring in the 6 months before and the 6 months after injection were recorded.
Before injection, the mean number of UTI over 6 months was 1.39±1.36. After injection, the mean significantly decreased to 0.78±0.96 (P=0.023). The mean maximum detrusor pressure during filling decreased significantly in the patients of detrusor overactivity (n=24) compared with patients of normo-active detrusor (n=17) after injection (35.4±12.2 vs 20.9±7.9 cmH(2)O, P=0.000), meantime, the decrease of UTI was significant in the former (1.29±1.21 vs 0.41±0.62 cmH(2)O, P=0.015) while no significant in the latter (1.46±1.47 vs 1.04±1.08, P=0.319).
Detrusor BoNTA injection significantly decreased UTI in SCI patients with NDO. This effect seems to be related to the decrease of detrusor pressure.
本研究设计为单臂临床试验。
探讨逼尿肌肉毒毒素 A（BoNTA）注射对脊髓损伤（SCI）患者尿路感染（UTI）的影响。
本研究在中国的一家国家康复研究中心进行。
2010 年 9 月至 2012 年 5 月，41 名男性 SCI 患者因神经源性逼尿肌过度活动（NDO）住院，平均年龄 36.0±8.8 岁，纳入后 SCI 持续时间 21.5±17.3 个月，将 300U BoNTA 注入逼尿肌。在注射前和注射后 3 个月，每位患者均保留膀胱日记，行视频尿动力学检查和尿液培养。记录注射前 6 个月和注射后 6 个月内发生的所有 UTI。
注射前，6 个月 UTI 平均发生 1.39±1.36 次。注射后，平均显著减少至 0.78±0.96（P=0.023）。逼尿肌过度活动患者（n=24）注射后最大逼尿肌压力在充盈期明显低于正常逼尿肌患者（n=17）（35.4±12.2 对 20.9±7.9cmH2O，P=0.000），同时，前者 UTI 减少明显（1.29±1.21 对 0.41±0.62cmH2O，P=0.015），而后者无明显变化（1.46±1.47 对 1.04±1.08，P=0.319）。
逼尿肌 BoNTA 注射可显著降低 SCI 合并 NDO 患者的 UTI。这种效果似乎与逼尿肌压力降低有关。
