Yamamoto Tatsuya, Asahina Masato, Yamanaka Yoshitaka, Uchiyama Tomoyuki, Hirano Shigeki, Sugiyama Atsuhiko, Sakakibara Ryuji, Kuwabara Satoshi
Department of Neurology Chiba University Graduate School of Medicine Chiba Japan.
Department of Neurology Continence Center Dokkyo Medical University Tochigi Japan.
Mov Disord Clin Pract. 2016 Jan 27;3(3):275-281. doi: 10.1002/mdc3.12289. eCollection 2016 May-Jun.
MSA is clinically classified into two phenotypes: parkinsonism predominant (MSA-P) and cerebellar ataxia predominant (MSA-C). However, little is known about the differences in urinary dysfunctions between MSA-C and MSA-P. We investigated the differences in urinary and cardiovascular dysfunctions between MSA-C and MSA-P.
We retrospectively reviewed the medical records of patients with MSA diagnosed as having probable or possible MSA according to Gilman's second consensus criteria from January 2007 to September 2013 in our hospital. Data regarding the initial symptoms, onset of urinary symptoms, and results of urodynamic (including anal sphincter electromyography) and head-up tilt tests were collected.
A total of 100 patients with MSA, including 59 patients with MSA-C and 41 with MSA-P, were reviewed. Initial symptoms were autonomic (n = 12) and cerebellar (n = 47) in the MSA-C phenotype and were autonomic (n = 14) and parkinsonian (n = 27) in the MSA-P phenotypes. Urodynamic study indicated that bladder contraction was more severely impaired in patients with MSA-P than in those with MSA-C. In the head-up tilt test, the decrease in diastolic blood pressure was significantly larger in the MSA-P phenotype than that in the MSA-C phenotype. Acontractile bladder during the pressure flow study increased likelihood that the phenotype is MSA-P (odds ratio: 6.67; 95% confidence interval: 1.004-44.284; = 0.050).
Urinary dysfunctions were more severe in MSA-P compared with MSA-C. Detailed urodynamic study was helpful for detecting subtle differences between MSA-C and MSA-P.
多系统萎缩（MSA）在临床上分为两种表型：帕金森综合征为主型（MSA-P）和小脑共济失调为主型（MSA-C）。然而，关于MSA-C和MSA-P之间排尿功能障碍的差异知之甚少。我们研究了MSA-C和MSA-P之间排尿和心血管功能障碍的差异。
我们回顾性分析了2007年1月至2013年9月在我院根据吉尔曼第二版共识标准诊断为可能或确诊MSA的患者的病历。收集了有关初始症状、排尿症状出现时间以及尿动力学（包括肛门括约肌肌电图）和头高位倾斜试验结果的数据。
共纳入100例MSA患者，其中MSA-C型59例，MSA-P型41例。MSA-C型的初始症状以自主神经症状（n = 12）和小脑症状（n = 47）为主，MSA-P型的初始症状以自主神经症状（n = 14）和帕金森症状（n = 27）为主。尿动力学研究表明，MSA-P患者的膀胱收缩功能受损比MSA-C患者更严重。在头高位倾斜试验中，MSA-P型患者舒张压的下降幅度明显大于MSA-C型患者。压力流研究中出现无收缩膀胱增加了该表型为MSA-P的可能性（优势比：6.67；95%置信区间：1.004 - 44.284；P = 0.050）。
与MSA-C相比，MSA-P的排尿功能障碍更严重。详细的尿动力学研究有助于发现MSA-C和MSA-P之间的细微差异。
