焦虑对女性膀胱过度活动症的生物心理社会影响。
The biopsychosocial impacts of anxiety on overactive bladder in women.
机构信息
Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Departments of Psychiatry and Behavioral Sciences and of Physical Medicine & Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
出版信息
Neurourol Urodyn. 2023 Apr;42(4):778-784. doi: 10.1002/nau.25152. Epub 2023 Feb 13.
AIMS
Links between emotional state and the bladder have long been recognized, as psychological comorbidity is a common feature of overactive bladder (OAB). However, how psychological factors might contribute to the development and severity of OAB remains unclear. Therefore, we sought to examine the effect of anxiety on OAB with a specific focus on bladder hypersensitivity.
METHODS
In a sample of 120 adult women with OAB, we compared those with at least mild anxiety (PROMIS Anxiety score ≥55) to those with lower anxiety. Analyses focused on patient-reported questionnaires assessing urinary symptom severity and quality of life, psychological stress symptoms, general somatic symptoms, and results of quantitative sensory testing (QST), including temporal summation to heat pain (TSP). TSP was used to index elevated C-fiber responsiveness (i.e., central sensitization).
RESULTS
Thirty-six (30%) women had at least mild anxiety. While there were no group differences for urinary symptom severity, more anxious women reported worse OAB-specific quality of life, greater psychological stress burden, higher stress reactivity, and greater somatic symptoms. On QST, there were no differences between anxiety groups for pain threshold (43.6 ± 3.1°C vs. 44.0 ± 3.1°C, p = 0.6) and tolerance (47.3 ± 1.5°C vs. 47.4 ± 1.6°C, p = 0.7). However, those with anxiety had significantly higher TSP than those without anxiety (6.0 ± 4.8 vs. 3.7 ± 3.9, p = 0.006), indicating greater central sensitization.
CONCLUSIONS
Women with OAB and at least mild anxiety symptoms reported greater psychosocial burdens (i.e., psychological stress, stress reactivity, OAB-specific QOL) and somatic symptom severity and demonstrated greater central sensitization on QST than those without anxiety. These findings support the hypothesis that anxiety and psychological stress impact hypersensitivity mechanisms that may underlie and contribute to OAB, although further research is needed to better understand how and to what extent.
目的
情绪状态与膀胱之间的联系早已被人们所认识，因为心理共病是膀胱过度活动症（OAB）的常见特征。然而，心理因素如何导致 OAB 的发生和严重程度尚不清楚。因此，我们试图研究焦虑对 OAB 的影响，特别关注膀胱过度敏感。
方法
在 120 名患有 OAB 的成年女性中，我们比较了至少有轻度焦虑（PROMIS 焦虑评分≥55）的患者和焦虑程度较低的患者。分析重点是评估尿症状严重程度和生活质量、心理压力症状、一般躯体症状以及定量感觉测试（QST）结果的患者报告问卷，包括热痛的时间总和（TSP）。TSP 用于评估升高的 C 纤维反应性（即中枢敏化）。
结果
36 名（30%）女性有至少轻度焦虑。虽然两组在尿症状严重程度上没有差异，但更焦虑的女性报告 OAB 特异性生活质量更差、心理压力负担更大、应激反应性更高、躯体症状更多。在 QST 上，焦虑组之间的疼痛阈值（43.6±3.1°C 与 44.0±3.1°C，p=0.6）和耐受度（47.3±1.5°C 与 47.4±1.6°C，p=0.7）没有差异。然而，焦虑组的 TSP 明显高于无焦虑组（6.0±4.8 与 3.7±3.9，p=0.006），表明中枢敏化程度更高。
结论
患有 OAB 且至少有轻度焦虑症状的女性报告了更大的心理社会负担（即心理压力、应激反应、OAB 特异性生活质量）和躯体症状严重程度，并且在 QST 上表现出更高的中枢敏化。这些发现支持了这样的假设，即焦虑和心理压力会影响导致和促成 OAB 的过度敏感机制，但需要进一步研究以更好地了解其方式和程度。
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