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題 名 | Treatment of Lower Urinary Tract Symptoms and Overactive Bladder--Focus on Bladder Sensory Innervation=下尿路症狀及膀胱過動症之治療--針對膀胱感覺神經 |
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作 者 | 陳鼎源; 郭漢崇; | 書刊名 | 慈濟醫學 |
卷 期 | 18:5 民95.10 |
頁 次 | 頁333-344+404 |
分類號 | 415.83 |
關鍵詞 | 感覺神經; 逼尿肌活性過強; 神經傳遞物質; 間質性膀胱炎; 膀胱過動症; Sensory innervation; Detrusor overactivity; Neurotransmitter; Interstitial cystitis; Overactive bladder; |
語 文 | 英文(English) |
中文摘要 | 下尿路症狀在現代是相當常見,尤其是在一些老年男人及女人,這些症狀對於健康相關的生活品質影響甚鉅,同時也對病人造成相當大的情緒影響以及社會的經濟支出。最近男性下尿路症狀的治療已經逐漸由膀胱出口阻塞轉移到針對膀胱功能失調,膀胱表皮被發現可以釋放一些例如乙醯膽鹼、ATP、P物質的神經多胜,以及一些與感覺相關的受器表現,如TRPV1及P2□。這些研究顯示肺胱表皮對於人類膀胱的機械性感覺具有重要的意義,而在膀胱壁表皮下的感覺神經也富含乙醯膽鹼及ATP,顯示膀胱的黏膜基底層在傳遞膀胱脹尿的訊息以及對膀胱擴張的反應扮演重要的角色。此外,神經生長因子也被發現在膀胱出口阻塞、膀胱過動症、女性間質性膀胱炎,在膀胱組織有增加的現象。根據這些最近的研究結果,許多膀胱的疾病諸如神經性逼尿肌活性過強、不明原因逼尿肌活性過強、間質性膀胱炎及因為膀胱出口阻塞所造成的膀胱過動症,或是膀胱表皮功能障礙,都可能有一些共同的致病路徑,並且與膀胱表皮下神經的傳遞物質分泌以及感覺神經受器的表現有相當密切的關係。因此,針對這些膀胱疾病在治療上可能需要針對膀胱表皮下的感覺受器之表現以及神經傳遞物質釋放之阻斷才能得而較為理想的治療結果。 |
英文摘要 | Lower urinary tract symptoms (LUTS) are highly prevalent, especially among elderly men and women, with a negative impact on health-related quality of life. LUTS are associated with great emotional costs for individuals and substantial economic costs for society. Recent investigation of LUTS in men noted that bladder dysfunction plays an important role in addition to bladder outlet obstruction. The urothelial release of nurotransmitters such as acetylcholine (ACh), adenosine triposphate (ATP) and the neuropeptide substance P, and the expression of TRPV1 and P2□ receptors strongly imply r a role for the urothelium in human bladder mechanosensation. An abundance of suburothelial sensory nerves and vesicles containing Ach and ATP in nerve fiber terminals have been found in the human bladder wall, suggesting the lamina propria of the bladder plays an important role in the transmission of a sensation of bladder fullness and in the bladder response to stretch. In addition, nerve growth factor levels have been shown to be elevated in the bladder tissues of men with bladder outlet obstruction, patients with overactive bladders, and women with interstitial cystitis. Based on the results from recent investigations, bladder disorders like nerogenic detrusor overactivity, idiopathic detrusor overactivity, interstitial cystitis, overactive bladder due to bladder outlet obstruction and urothelial dysfunction might have a common pathway in the abnormality of expression of sensory receptors or release of transmitters in the suburothelia never or interstitial cells. In this regard, inhibition of receptor expression or transmitter release in the sensory nerve terminals in the suburothelial space might provide good therapeutic effects in the treatment of sensory urgency, interstitial cystitis and detrusor overactivity. |
本系統中英文摘要資訊取自各篇刊載內容。