Song Qi-Xiang, Chermansky Christopher J, Birder Lori A, Li Longkun, Damaser Margot S
Department of Urology, Changhai Hospital, Shanghai, PR China.
Department of Urology, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA 15261, USA.
Nat Rev Urol. 2014 Oct;11(10):579-88. doi: 10.1038/nrurol.2014.244. Epub 2014 Sep 16.
Urinary incontinence adversely affects quality of life and results in an increased financial burden for the elderly. Accumulating evidence suggests a connection between neurotrophins, such as brain-derived neurotrophic factor (BDNF), and lower urinary tract function, particularly with regard to normal physiological function and the pathophysiological mechanisms of stress urinary incontinence (SUI) and bladder pain syndrome/interstitial cystitis (BPS/IC). The interaction between BDNF and glutamate receptors affects both bladder and external urethral sphincter function during micturition. Clinical findings indicate reduced BDNF levels in antepartum and postpartum women, potentially correlating with postpartum SUI. Experiments with animal models demonstrate that BDNF is decreased after simulated childbirth injury, thereby impeding the recovery of injured nerves and the restoration of continence. Treatment with exogenous BDNF facilitates neural recovery and the restoration of continence. Serotonin and noradrenaline reuptake inhibitors, used to treat both depression and SUI, result in enhanced BDNF levels. Understanding the neurophysiological roles of BDNF in maintaining normal urinary function and in the pathogenesis of SUI and BPS/IC could lead to future therapies based on these mechanisms.
尿失禁对生活质量产生不利影响，并导致老年人的经济负担增加。越来越多的证据表明，神经营养因子，如脑源性神经营养因子（BDNF），与下尿路功能之间存在联系，特别是在正常生理功能以及压力性尿失禁（SUI）和膀胱疼痛综合征/间质性膀胱炎（BPS/IC）的病理生理机制方面。BDNF与谷氨酸受体之间的相互作用在排尿过程中影响膀胱和尿道外括约肌的功能。临床研究结果表明，产前和产后女性的BDNF水平降低，这可能与产后压力性尿失禁相关。动物模型实验表明，模拟分娩损伤后BDNF减少，从而阻碍受损神经的恢复和控尿功能的恢复。外源性BDNF治疗有助于神经恢复和控尿功能的恢复。用于治疗抑郁症和压力性尿失禁的5-羟色胺和去甲肾上腺素再摄取抑制剂可提高BDNF水平。了解BDNF在维持正常排尿功能以及压力性尿失禁和膀胱疼痛综合征/间质性膀胱炎发病机制中的神经生理作用，可能会带来基于这些机制的未来治疗方法。
