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

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.