Beijing Da Xue Xue Bao Yi Xue Ban.
2021 Aug 18; 53(4): 653–658.
Language:
Chinese
|
English
间质性膀胱炎/膀胱疼痛综合征患者生活质量及相关因素分析
Quality of life and related factors in patients with interstitial cystitis/bladder pain syndrome
,
1,
2
,
2
,
2
,
2
,
2
and
1,
2,
*
王 佳文
北京大学第五临床医学院，北京医院泌尿外科，北京 100730,
Department of Urology, Peking University Fifth School of Clinical Medicine, Beijing Hospital, Beijing 100730, China
北京医院，国家老年医学中心，尿控盆底疾病诊治中心，北京 100730,
National Center of Gerontology, Beijing Hospital Continence Center, Beijing 100730, China
刘 敬超
北京医院，国家老年医学中心，尿控盆底疾病诊治中心，北京 100730,
National Center of Gerontology, Beijing Hospital Continence Center, Beijing 100730, China
孟 令峰
北京医院，国家老年医学中心，尿控盆底疾病诊治中心，北京 100730,
National Center of Gerontology, Beijing Hospital Continence Center, Beijing 100730, China
张 威
北京医院，国家老年医学中心，尿控盆底疾病诊治中心，北京 100730,
National Center of Gerontology, Beijing Hospital Continence Center, Beijing 100730, China
刘 晓东
北京医院，国家老年医学中心，尿控盆底疾病诊治中心，北京 100730,
National Center of Gerontology, Beijing Hospital Continence Center, Beijing 100730, China
张 耀光
北京大学第五临床医学院，北京医院泌尿外科，北京 100730,
Department of Urology, Peking University Fifth School of Clinical Medicine, Beijing Hospital, Beijing 100730, China
北京医院，国家老年医学中心，尿控盆底疾病诊治中心，北京 100730,
National Center of Gerontology, Beijing Hospital Continence Center, Beijing 100730, China
北京大学第五临床医学院，北京医院泌尿外科，北京 100730,
Department of Urology, Peking University Fifth School of Clinical Medicine, Beijing Hospital, Beijing 100730, China
北京医院，国家老年医学中心，尿控盆底疾病诊治中心，北京 100730,
National Center of Gerontology, Beijing Hospital Continence Center, Beijing 100730, China
Age/years,
x
±
s
46.4±14.346.2±13.10.852Disease duration/months,
x
±
s
39.4±51.627.0±40.80.008BMI,
x
±
s
22.1±2.822.9±3.00.016Smoking,
n
(%)0.315 No108 (99.1)446 (96.7) Yes1 (0.9)15 (3.3)Drinking,
n
(%)0.759 No106 (97.2)453 (98.3) Yes3 (2.8)8 (1.7)Caffeine intake,
n
(%)0.956 No103 (94.5)435 (94.4) Yes6 (5.5)26 (5.6)Constipation,
n
(%)0.006 No91 (83.5)325 (70.5) Yes18 (16.5)136 (29.5)Marital status,
n
(%)0.090 Married98 (89.9)435 (94.4) Unmarried or divorced11 (10.1)26 (5.6)First visit due to LUTS,
n
(%)< 0.001 No29 (26.6)21 (4.6) Yes80 (73.4)440 (95.4)OABSS scores,
x
±
s
7.1±3.26.6±3.20.210AUA-SI scores,
x
±
s
14.5±6.711.7±5.9< 0.001
两组患者比较，IC/BPS组患者平均病程较长(
P
=0.008)，初次因本疾病就诊的患者比例较低(
P
< 0.001)，AUA-SI评分较高(
P
< 0.001);OAB组患者BMI较高(
P
=0.016)，便秘发生率较高(
P
=0.006)。两组患者的平均年龄、吸烟、饮酒、咖啡因摄入(茶、咖啡等)、婚姻状况、OABSS评分差异无统计学意义。
2.2. IC/BPS和OAB对患者日常生活的影响
对IC/BPS和OAB患者的出行社交、工作、运动、家庭、性生活、心理情绪几方面进行评估，结果显示IC/BPS对患者家庭生活方面影响最大，其次为出行社交，这与OAB患者的评估结果相似。IC/BPS相关症状对患者家庭生活影响程度评分显著高于OAB组(
P
=0.003)，两组患者在出行社交、工作、运动、性生活、心理情绪几方面的差异无统计学意义(
)。
表 2
IC/BPS和OAB对患者日常生活的影响
Effects of IC/BPS and OAB on different aspects of life
|
Items
|
IC/BPS (
n
=109),
M
(
P
25
,
P
75
)
|
OAB (
n
=461),
M
(
P
25
,
P
75
)
|
P
value
|
|
Abbreviations as in
.
|
|
Social activities
|
4 (3, 5)
|
4 (3，5)
|
0.165
|
|
Work
|
2 (1, 3)
|
2 (1, 4)
|
0.116
|
|
Sports
|
2 (0, 3)
|
2 (1, 4)
|
0.057
|
|
Daily life
|
4 (4, 5)
|
4 (3, 5)
|
0.003
|
|
Sexual life
|
2 (0, 4)
|
2 (1, 4)
|
0.251
|
|
Psychological emotions
|
2 (0, 3)
|
2 (1, 4)
|
0.187
|
2.3. IC/BPS和OAB患者的生活质量比较
IC/BPS和OAB对患者生活质量的影响均以下尿路症状(lower urinary tract symptoms，LUTS)为主。困扰IC/BPS患者的前三位症状分别是疼痛(45%)、尿频(28%)和尿急(17%)，困扰OAB患者的前三位症状分别是尿急(43%)、尿频(40%)和夜尿(6%)。储尿期、排尿期、排尿后症状对患者生活质量影响评分见
，IC/BPS和OAB症状对患者的生活质量影响均以储尿期症状为主。IC/BPS患者的储尿期、排尿期、排尿后症状对生活质量影响的评分均高于OAB患者，其中IC/BPS患者储尿期症状对生活质量影响的评分显著高于OAB患者(
P
< 0.001)，排尿期、排尿后症状对生活质量影响的评分与OAB组相比差异无统计学意义。
表 3
IC/BPS和OAB患者生活质量评分比较
Comparison of quality of life scores between IC/BPS and OAB patients
|
Impacts on quality of life score
|
IC/BPS (
n
=109),
M
(
P
25
,
P
75
)
|
OAB (
n
=461),
M
(
P
25
,
P
75
)
|
P
value
|
|
Abbreviations as in
.
|
|
Storage symptoms
|
8 (6, 8)
|
6 (5, 7)
|
< 0.001
|
|
Voiding symptoms
|
3 (1, 6)
|
4 (1, 5)
|
0.846
|
|
Post-voiding symptoms
|
4 (1, 6)
|
4 (1, 6)
|
0.735
|
2.4. IC/BPS患者生活质量相关因素分析
根据IC/BPS对患者生活质量影响程度将109例患者分为轻-中度组(
n
=46)和重度组(
n
=63)，对两组患者的数据进行比较，结果显示两组患者的年龄、病程、BMI、吸烟、饮酒、是否初诊以及婚姻状况之间的差异均无统计学意义，咖啡因摄入(
P
=0.034)、便秘(
P
=0.003)可能是影响IC/BPS患者生活质量的相关因素(
)。
表 4
IC/BPS患者生活质量相关因素分析
Related factors of quality of life in patients with IC/BPS
|
Items
|
Mild and moderate (
n
=46)
|
Severe (
n
=63)
|
P
value
|
|
Abbreviations as in
.
|
|
Age/years,
x
±
s
|
48.4±15.6
|
45.0±13.3
|
0.302
|
|
Disease duration/months,
x
±
s
|
40.9±56.4
|
38.3±48.3
|
0.789
|
|
BMI,
x
±
s
|
21.8±2.7
|
22.3±2.9
|
0.805
|
|
Smoking,
n
(%)
|
|
|
0.578
|
|
No
|
46 (100.0)
|
62 (98.4)
|
|
|
Yes
|
0 (0)
|
1 (1.6)
|
|
|
Drinking,
n
(%)
|
|
|
0.189
|
|
No
|
46(100.0)
|
60 (95.2)
|
|
|
Yes
|
0 (0)
|
3 (4.8)
|
|
|
Caffeine intake,
n
(%)
|
|
|
0.034
|
|
No
|
46 (100.0)
|
57 (90.5)
|
|
|
Yes
|
0 (0)
|
6 (9.5)
|
|
|
Constipation,
n
(%)
|
|
|
0.003
|
|
No
|
44 (95.7)
|
47 (74.6)
|
|
|
Yes
|
2 (4.3)
|
16 (25.4)
|
|
|
Marital status,
n
(%)
|
|
|
0.234
|
|
Married
|
43 (93.5)
|
55 (87.3)
|
|
|
Unmarried or divorced
|
3 (6.5)
|
8 (12.7)
|
|
|
First visit due to LUTS,
n
(%)
|
|
|
0.548
|
|
No
|
12 (26.0)
|
17 (27.0)
|
|
|
Yes
|
34 (74.0)
|
46 (73.0)
|
|
3. 讨论
IC/BPS比较容易被泌尿外科医生忽视，由于部分医生对IC/BPS疾病的认识不够且缺乏诊断的金标准，可能导致IC/BPS的患病率被明显低估。IC/BPS的发病机制尚未完全清楚
[
7
]
，目前探讨较多的机制包括细菌假说、膀胱损伤假说、氨基葡聚糖(glycosaminoglycan，GAG)层缺陷假说、神经源性因素和自身免疫因素等
[
8
]
。OAB是一种以尿急症状为特征的临床症候群
[
9
]
，典型症状包括尿急、尿频、夜尿，严重者可发生急迫性尿失禁。与IC/BPS类似，OAB尚无完全治愈的手段，目前国内外均建议将OAB作为慢性病纳入长期管理，目的是缓解症状、提高患者的生活质量。
IC/BPS和OAB患者在临床表现等方面存在一定相似性，本研究结果显示，IC/BPS和OAB的人口学特征存在一定差异，IC/BPS的难治性更高于OAB，患者平均病程较长，多次就诊的比例较高。OAB组患者的BMI和便秘发生率较高，与既往相关研究结果类似，即肥胖
[
10
]
、便秘
[
11
]
是OAB的危险因素。
本研究评估了IC/BPS对患者出行社交、工作、运动、家庭、性生活、心理情绪方面的影响，结果提示IC/BPS对患者的家庭生活(如做家务等)和社交活动影响较大。有研究对IC/BPS患者的工作情况进行了分析
[
12
]
，所有入组患者中有42%的女性失业，其中11%的患者认为这是IC/BPS症状的直接结果。医生在病史采集过程中容易忽略性生活问题，然而性生活已在一些研究中被证明是IC/BPS患者身体和心理生活质量的重要指标
[
13
]
。意外的是，本研究中的患者认为IC/BPS对自身心理情绪的影响并不突出，这与临床观察到的情况相反。临床上，IC/BPS往往比OAB患者表现出更快的语速和更大的情绪波动，这可能由于本研究的量表为主观自评量表，患者对自身情绪问题的粗略判断缺乏专业性。既往研究认为，IC/BPS对患者的心理影响是普遍且严重的
[
14
-
15
]
，IC/BPS可能增加患者焦虑、抑郁等的风险
[
16
]
。尽管有研究认为焦虑的严重程度可能不影响IC/BPS患者的治疗结果
[
17
]
，但泌尿科医师还是应当警惕和及时治疗IC/BPS患者可能发生的心理并发症。
本研究通过VAS评估了IC/BPS或OAB症状对患者生活质量的影响程度。VAS最初用于疼痛评分，0表示无痛，10表示难以忍受的剧痛，能比较客观地反映患者的生活质量和疾病的困扰程度
[
18
]
。目前，VAS已在泌尿外科得到广泛应用，如视觉前列腺症状评分(visual prostate symptom score，VPSS)
[
19
]
、尿流率视觉量表(visual uroflow scale，VUS)
[
20
]
等。本研究中VAS的结果提示，IC/BPS对患者生活质量的影响要比OAB严重，这与Thu等
[
21
]
的研究结果类似。IC/BPS对患者生活质量的影响以储尿期症状为主，患者主诉往往同时包括疼痛、尿频和尿急症状。
本研究根据生活质量的受影响程度对IC/BPS患者进行了分组并比较，结果显示咖啡因摄入和便秘可能是影响IC/BPS患者生活质量的相关因素。除茶、咖啡等含咖啡因的饮品
[
22
]
，以往有研究显示，柑橘类水果、碳酸饮料、含酒精的饮料以及辛辣食物往往也会加剧症状，而甘油磷酸钙和碳酸氢钠则倾向于改善IC/BPS症状
[
23
]
。因不同患者对具体食物的敏感性不同，可能受到合并症或其他因素的影响，饮食和生活习惯作为可控的潜在刺激因素，医生在临床工作中可以建议患者调节饮食、改善生活习惯以缓解症状。
本研究尚存在一定局限性。由于本研究中的量表为受测者主观自评，受测者可能会避免极端的选择(趋中倾向性偏差)，习惯性认同陈述性语句(惯性偏差)或揣摩并迎合研究者的期望结果(社会赞许偏差)。除此之外，本研究未进行严格的分组和分层，研究结果可能存在一定偏倚。研究组样本量相对不足，分析能力受到影响，尚需更大样本量以进一步研究。
综上所述，本研究通过多中心横断面研究显示IC/BPS对患者的生活质量影响较大且以储尿期症状为主，泌尿外科医生应重视IC/BPS对患者身心健康的影响，可通过建议患者调节饮食、改善生活习惯以减轻症状，提高患者生活质量。
Funding Statement
国家重点研发计划(2018YFC2002200)
Supported by the National Key Research and Development Program of China (2018YFC2002200)
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