膀胱逼尿肌反射低下的病患中有復原及無復原者尿液中的生物標記蛋白的表現
陳聖復1、張嘉慧1、郭漢崇1
1佛教花蓮慈濟綜合醫院泌尿部
Urinary biomarkers in patients with detrusor underactivity with and without bladder function recovery
Sheng-Fu Chen1, Chia-Hwei Chang1, Hann-Chorng Kuo1
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University1
Purpose: Detrusor underactivity (DU) is frequently encountered in elderly patients with chronic medical disease or neurological diseases. The pathophysiology of DU may involve neurogenic, myogenic and bladder outlet pathologies. Part of patients with DU might have bladder function recovery after treatment. This study investigated the urinary proteins in these patients in comparison with patients with detrusor overactivity (DO), detrusor hyperactivity and inadequate contractility (DHIC), and patients with normal urodynamic tracing.
Materials and Methods: A total of 37 patients with chronic urinary retention and urodynamically proven DU were enrolled. After medical or surgical treatment, 24 DU patients had bladder function recovery whereas 13 had not, after one-year follow-up. Urine collection at baseline was performed and the urinary protein including nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF) and prostaglandin E2 (PGE2) were measured by ELISA. 20 urodynamically normal, 34 DO and 15 DHIC patients served as comparative groups.
Results: Patients with DU had significantly higher urinary NGF (9.2 ± 20.3 v 1.85 ± 2.9, p = 0.037), BDNF (153.4 ± 199.1 v 77.4 ± 47.7 pg/ml, p = 0.033) ) and PGE2 (525.3 ± 269.3 pg/ml v 971.4 ± 811.4 , p = 0.004) levels than those in normal group, but not higher than those in DO and DHIC groups (Table 1). In DU patients with bladder function recovery, the urinary levels of BDNF and PGE2 were significantly higher than the normal group (190± 239 v 77.4 ± 47.7, p = 0.033; 1290±836 v 525.3 ± 269.3, p < 0.0001, respectively) (Table 2). The urinary NGF and BDNF levels in the recovery DU group were similar to, but PGE2 was significantly higher than non-recovery group (1290 ± 836.3 v 382.8 ± 237.0, p = 0.001) or DO group (1290 ± 836.3 v 740.8 ± 597.1, p = 0.020).
Conclusions: Patients with DU and higher urinary PGE2 and BDNF levels might have a chance to recover bladder function than those with a lower protein level. Urinary protein levels provide prognostic value of bladder function and dysfunction.