Correlation of Urinary Dysfunction and Autonomic Nervous Function in Patients with Cerebral Small Vessel 
Disease

doi:10.3969/j.issn.1673-5765.2023.01.007

Abstract

Abstract:

Objective To investigate the correlation between urinary dysfunction and autonomic nervous function in patients with cerebral small vessel disease (CSVD).

Methods This cross-sectional study included consecutive CSVD patients from Beijing Tiantan Hospital, Capital Medical University between January 2020 and January 2021. The urinary function was assessed using the overactive bladder syndrome score (OABSS) and autonomic nervous function was assessed using heart rate variability (HRV). According to whether they met the overactive bladder (OAB) diagnosis criteria, the patients were divided into OAB group and non-OAB group, and the differences in CSVD imaging markers and HRV parameters between the two groups were analyzed. Spearman’s correlation analysis was used to analyze the association between voiding disorders and autonomic nervous dysfunction in CSVD patients.

Results A total of 71 CSVD patients were included in this study, 17 cases (23.9%) were diagnosed with OAB, and 64 cases (90.1%) had the complete data of HRV, urinary function and CSVD imaging assessment. Compared to non-OAB patients, the OAB patients were older[ (66.5±10.1) years vs. (57.6±10.8) years, P=0.003], lower percentage of males (47.1% vs. 79.6%, P=0.009) and had more severe white matter hyperintensity (WMH) (76.5% vs. 49.0%, P=0.048). No statistical differences in HRV parameters were found between the two groups. After adjusting for age and sex, the partial correlation analysis showed that the score of OABSS was negatively correlated with the root mean square differences of successive R-R intervals (RMSSD) (r=-0.25, P<0.05) and the percentage of R-R intervals with >50 ms of variation (pNN50) (r=-0.30, P<0.05). In addition, the RMSSD was negatively correlated with urge urinary incontinence (r=-0.25, P<0.05), pNN50 was negatively correlated with the number of nocturnal urination (r=-0.28, P<0.05) and urge urinary incontinence (r=-0.28, P<0.05). For HRV, the ratio of low frequency and high frequency (LF/HF) was negatively correlated with the urgency score (r=-0.28, P<0.05).

Conclusions The urinary dysfunction in patients with CSVD may be associated with autonomic nervous dysfunction.

Key words: Cerebral small vessel disease; White matter hyperintensity; Urinary dysfunction; Overactive bladder; Autonomic nervous dysfunction

摘要：

目的探讨脑小血管病（cerebral small vessel disease，CSVD）患者排尿功能紊乱与自主神经功能的相关性。

方法采用横断面研究的方法，连续性纳入2020年1月—2021年1月首都医科大学附属北京天坛医院收治的符合入排标准的CSVD患者。使用膀胱过度活动症评分表（overactive bladder syndrome score，OABSS）评估患者的排尿功能，使用心率变异性（heart rate variability，HRV）评估患者的自主神经功能。根据患者是否符合膀胱过度活动症（overactive bladder，OAB）诊断标准将患者分为OAB组和非OAB组，分析两组患者CSVD影像特征和HRV参数的差异。进一步采用Spearman相关分析评估CSVD患者排尿障碍与自主神经功能紊乱的相关性。
结果共71例CSVD患者纳入分析，其中17例（23.9%）符合临床OAB的诊断标准，64例（90.1%）CSVD患者具有完整的HRV数据、排尿功能评估和影像资料。与非OAB组患者相比，OAB组患者年龄更大[（66.5±10.1）岁 vs.（57.6±10.8）岁，P=0.003]、男性比例更低（47.1% vs. 79.6%，P=0.009）、脑白质高信号更严重（76.5% vs. 49.0%，P=0.048）。OAB组与非OAB组患者HRV参数比较差异均无统计学意义。校正年龄和性别的偏相关分析结果显示，全部正常相邻R-R间期差值的均方根（r=-0.25，P<0.05）和相邻两个正常窦性R-R间期之差＞50 ms的个数占总窦性心搏个数的百分比（r=-0.30，P<0.05）与OABSS总分呈负相关。此外，全部正常相邻R-R间期差值的均方根与急迫性尿失禁评分呈负相关（r=-0.25，P<0.05），相邻两个正常窦性R-R间期之差＞50 ms的个数占总窦性心搏个数的百分比与夜间排尿次数（r=-0.28，P<0.05）和急迫性尿失禁评分（r=-0.28，P<0.05）呈负相关，低频功率与高频功率比值与尿急评分呈负相关（r=-0.28，P<0.05）。
结论 CSVD患者排尿功能障碍与自主神经功能紊乱可能有关。

关键词: 脑小血管病; 脑白质高信号; 排尿障碍; 膀胱过度活动症; 自主神经功能紊乱

TIAN Yu, GUAN Ling, WANG Yilong. Correlation of Urinary Dysfunction and Autonomic Nervous Function in Patients with Cerebral Small Vessel Disease[J]. Chinese Journal of Stroke, 2023, 18(01): 76-82.

田雨, 管玲, 王伊龙. 脑小血管病患者排尿功能紊乱与自主神经功能的相关性研究 [J]. 中国卒中杂志, 2023, 18(01): 76-82.

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Correlation of Urinary Dysfunction and Autonomic Nervous Function in Patients with Cerebral Small Vessel Disease

脑小血管病患者排尿功能紊乱与自主神经功能的相关性研究

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