Sakakibara Ryuji, Takahashi Osamu, Nishimura Haruka, Tateno Fuyuki, Kishi Masahiko, Tsuyusaki Yohei, Aiba Yosuke, Tatsuno Ichiro
Neurology, Internal Medicine, Sakura Medical Center, Toho University, Japan.
Clinical Physiology Unit, Sakura Medical Center, Toho University, Japan.
Intern Med. 2018 Aug 1;57(15):2165-2168. doi: 10.2169/internalmedicine.9749-17. Epub 2018 Feb 9.
Objective Diabetes commonly affects the bladder nerves. However, the relationship among bladder, periarterial and somatic neuropathy in diabetes is not well known. In the present study we investigated these relationships. Methods A total of 110 diabetic subjects were enrolled in the study. All were referred for screening for diabetic neuropathy, irrespective of their symptoms. The patients included 61 men and 49 women; the mean age was 59.3 years (31-85 years); the mean disease duration was 14.0 years (5-30 years); and the mean HbA1c value was 10.1% (5.1-16.3%). We performed a nerve conduction study (NCS, A-alpha/beta and B fiber), ultrasound-based measurement of the post-void residual (PVR) volume (abnormal, >50 mL, mainly A-delta/C fiber) and postural blood pressure measurement (abnormal, >-20 mmHg, A-delta/C fiber). Fisher's exact probability test and Student's t-test were used to analyze the significance of differences. Results NCS abnormality, an abnormal PVR volume, and postural hypotension were noted in 74, 19, and 36 of the subjects, respectively. There were clear relationships between NCS and an abnormal PVR volume (p<0.05), postural hypotension and an abnormal PVR volume (p<0.05), or NCS and postural hypotension (p<0.01). There were also subjects who had NCS abnormality alone, a high PVR volume alone or postural hypotension alone. An abnormal PVR volume was not associated with the HbA1c value, but was clearly related to the duration of diabetes (p<0.05). Conclusion Bladder dysfunction was correlated with somatic and periarterial neuropathy. On the other hand, 16% of the cases of bladder dysfunction occurred in patients without somatic or periarterial neuropathy; thus, the regular measurement of the PVR volume is necessary.
目的 糖尿病常影响膀胱神经。然而，糖尿病患者膀胱、动脉周围及躯体神经病变之间的关系尚不清楚。在本研究中，我们对这些关系进行了调查。方法 本研究共纳入110例糖尿病患者。所有患者均因糖尿病神经病变筛查而就诊，不论其有无症状。患者中男性61例，女性49例；平均年龄59.3岁（31 - 85岁）；平均病程14.0年（5 - 30年）；平均糖化血红蛋白（HbA1c）值为10.1%（5.1 - 16.3%）。我们进行了神经传导研究（NCS，A - α/β和B纤维）、基于超声的排尿后残余尿量（PVR）测量（异常标准为>50 mL，主要涉及A - δ/C纤维）以及体位性血压测量（异常标准为> - 20 mmHg，A - δ/C纤维）。采用Fisher精确概率检验和Student t检验分析差异的显著性。结果 NCS异常、PVR量异常及体位性低血压分别在74例、19例和36例受试者中出现。NCS与PVR量异常（p<0.05）、体位性低血压与PVR量异常（p<0.05）或NCS与体位性低血压（p<0.01）之间存在明显关联。也有仅NCS异常、仅PVR量高或仅体位性低血压的受试者。PVR量异常与HbA1c值无关，但与糖尿病病程明显相关（p<0.05）。结论 膀胱功能障碍与躯体及动脉周围神经病变相关。另一方面，16%的膀胱功能障碍病例发生在无躯体或动脉周围神经病变的患者中；因此，定期测量PVR量是必要的。
