导读：英国研究人员不久前发现，肉毒杆菌除具有人们熟知的美容功效外，还可用于治疗尿失禁。在临床试验中接受肉毒杆菌注射的患者，每天上厕所的次数及尿液失控流出的次数都明显减少，改善了患者的生活质量。
英国莱斯特大学等机构的研究者在新一期《欧洲泌尿学》上报告说，他们请240名女性参与临床试验，她们都患有比较严重的膀胱过度活动症。这种病是医学上对难以自控的尿频和尿失禁等现象的称呼，据估计在40岁以上的中老年人中约20%的人都有这个问题，其中又以女性居多。这种病对患者的生活往往造成很大困扰。
在本次研究中，约一半受试者接受了在膀胱壁部位注射肉毒杆菌。肉毒杆菌具有麻痹肌肉的效果，美容上就是用这个功能来消除面部皱纹。研究结果显示，肉毒杆菌也能很好地缓解膀胱过度活动症的症状，接受注射者与未如此注射的对照组成员相比，前者每天需要上厕所的次数显著下降，每天出现尿失禁的次数从平均6次降至1.67次。此外，一些人在接受注射后能完全控制自己不出现尿失禁现象，其中约五分之二的人在接受注射后6周内都能保持这种能力，约三分之一的人能保持6个月。
领导这项研究的道格拉斯·廷切洛说，上述肉毒杆菌试验的效果超过了现在许多尿失禁治疗药物，接受注射的患者由于生活质量改善而对其疗效感到满意，以至愿意承担相关副作用。据介绍，这种注射的副作用包括肉毒杆菌可能过度麻痹相关肌肉，导致正常排尿能力受影响，需要使用导尿管。此外，接受注射者出现尿道感染的风险也会上升。
OnabotulinumtoxinA Improves Health-Related Quality of Life in Patients With Urinary Incontinence Due to Idiopathic Overactive Bladder: A 36-Week, Double-Blind, Placebo-Controlled, Randomized, Dose-Ranging Trial
Clare J. Fowler , Stephen Auerbach , David Ginsberg , Douglass Hale , Piotr Radziszewski , Tomasz Rechberger , Vaishali D. Patel , Jihao Zhou , Catherine Thompson , Jonathan W. Kowalski .
Background Patients with urgency urinary incontinence (UUI) due to overactive bladder (OAB) refractory to oral antimuscarinics have limited therapeutic options. OnabotulinumtoxinA appears to be an effective new treatment.
Objective Assess disease-specific quality-of-life outcomes and general health–related quality-of-life (HRQOL) outcomes following treatment with onabotulinumtoxinA in patients with idiopathic OAB and UUI inadequately managed with antimuscarinics.
Design, setting, and participants A phase 2, randomized, double-blind, placebo-controlled, dose-ranging study conducted at 40 sites from July 2005 to June 2008 with 313 patients (288 females) with idiopathic OAB experiencing eight or more UUI episodes per week and eight or more micturitions per day at baseline, with follow-up of 36 wk.
Outcome measurements and statistical analysis HRQOL was assessed using the urinary Incontinence-Specific Quality-of-Life Instrument (I-QOL), the King's Health Questionnaire (KHQ) symptom component, and the Medical Outcomes Study 36-Item Short-Form Health Survey. Descriptive statistics were used for absolute scores/changes from baseline. Within-group changes from baseline were assessed using paired t tests. Change from baseline for each onabotulinumtoxinA group compared with placebo was analyzed using an analysis of covariance model.
Results and limitations OnabotulinumtoxinA treatment at doses ≥100 U produced significantly greater improvements than placebo in the I-QOL total and subscale scores at all follow-up visits from week 2 through week 24 (p < 0.05). OnabotulinumtoxinA doses ≥100 U produced significantly greater improvements than placebo in the KHQ symptom score at a majority of follow-up visits. HRQOL instruments demonstrated low to moderate correlations (Spearman correlation range: 0.01–0.51) with the symptoms of UUI recorded using daily diary data, with I-QOL demonstrating the highest correlations. A study limitation was that certain quality-of-life measures were exploratory and not validated.
Conclusions A single onabotulinumtoxinA treatment with doses ≥100 U resulted in statistically significant and clinically meaningful improvement in HRQOL by week 2 compared with placebo, and this improvement was sustained for ≤36 wk in patients with idiopathic OAB and UUI who were inadequately managed by oral antimuscarinics.
文献链接：https://www.europeanurology.com/article/S0302-2838(12)00315-6/fulltext
