Hsu Lin-Nei, Hu Ju-Chuan, Chen Po-Yen, Lee Wei-Chia, Chuang Yao-Chi
Department of Urology, An Nan Hospital, China Medical University, Tainan City 833, Taiwan.
Division of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung 407, Taiwan.
Biomedicines. 2022 Aug 12;10(8):1957. doi: 10.3390/biomedicines10081957.
Metabolic syndrome (MetS) is defined by a group of cardiovascular risk factors, including impaired glucose tolerance, central obesity, hypertension, and dyslipidemia. Overactive bladder (OAB) syndrome consists of symptoms such as urinary urgency, frequency, and nocturia with or without urge incontinence. The high prevalences of metabolic syndrome (MetS) and overactive bladder (OAB) worldwide affect quality of life and cause profound negative impacts on the social economy. Accumulated evidence suggests that MetS might contribute to the underlying mechanisms for developing OAB, and MetS-associated OAB could be a subtype of OAB. However, how could these two syndromes interact with each other? Based on results of animal studies and observations in epidemiological studies, we summarized the common pathophysiologies existing between MetS and OAB, including autonomic and peripheral neuropathies, chronic ischemia, proinflammatory status, dysregulation of nutrient-sensing pathways (e.g., insulin resistance at the bladder mucosa and excessive succinate intake), and the probable role of dysbiosis. Since the MetS-associated OAB is a subtype of OAB with distinctive pathophysiologies, the regular and non-specific medications, such as antimuscarinics, beta-3 agonist, and botulinum toxin injection, might lead to unsatisfying results. Understanding the pathophysiologies of MetS-associated OAB might benefit future studies exploring novel biomarkers for diagnosis and therapeutic targets on both MetS and OAB.
代谢综合征（MetS）由一组心血管危险因素定义，包括糖耐量受损、中心性肥胖、高血压和血脂异常。膀胱过度活动症（OAB）综合征由尿急、尿频、夜尿等症状组成，伴或不伴有急迫性尿失禁。代谢综合征（MetS）和膀胱过度活动症（OAB）在全球的高患病率影响生活质量，并对社会经济造成深远的负面影响。越来越多的证据表明，MetS可能促成了OAB发生发展的潜在机制，且与MetS相关的OAB可能是OAB的一种亚型。然而，这两种综合征是如何相互作用的呢？基于动物研究结果和流行病学研究观察，我们总结了MetS和OAB之间存在的共同病理生理学，包括自主神经和周围神经病变、慢性缺血、促炎状态、营养感应通路失调（如膀胱黏膜处的胰岛素抵抗和琥珀酸盐摄入过多）以及肠道菌群失调的可能作用。由于与MetS相关的OAB是具有独特病理生理学的OAB亚型，常规和非特异性药物，如抗胆碱能药物、β-3激动剂和肉毒杆菌毒素注射，可能会导致不尽人意的结果。了解与MetS相关的OAB的病理生理学可能有助于未来探索用于诊断的新型生物标志物以及针对MetS和OAB的治疗靶点的研究。
