|
|
女性压力性尿失禁的影响因素研究进展
|
Abstract:
女性压力性尿失禁是一种由腹压突然增加引发尿液不自主流出的常见疾病，降低女性生活质量及导致社交障碍。随着我国人口老龄化，SUI的患病率逐年上升，其发生机制主要与盆底支持结构功能的减弱和尿道括约肌的退化密切相关。本文系统综述了影响女性SUI的主要危险因素，包括年龄增长和激素水平变化、妊娠与分娩方式、肥胖与体质指数升高、慢性疾病(如糖尿病、高血压、慢性咳嗽)以及盆腔脏器脱垂(Pelvic Organ Prolapse, POP)。本文通过综述分析SUI的相关危险因素，为个性化干预、疾病筛查及综合管理提供科学依据。
Female stress urinary incontinence (SUI) is a common disorder of involuntary urine outflow triggered by a sudden increase in abdominal pressure, which reduces women’s quality of life and leads to social barriers. With the aging of China’s population, the prevalence of SUI has been increasing year by year, and its occurrence mechanism is mainly closely related to the weakening of the pelvic floor support structures and the deterioration of the urethral sphincter. In this paper, we systematically review the major risk factors affecting SUI in women, including aging and hormone level changes, pregnancy and delivery mode, obesity and elevated body mass index, chronic diseases (e.g., diabetes mellitus, hypertension, chronic cough), and pelvic organ prolapse (POP). This article reviews and analyzes the risk factors associated with SUI to provide a scientific basis for personalized intervention, disease screening, and comprehensive management.
| [1] | 孔北华, 马丁, 段涛, 等. 妇产科学[M]. 第10版. 北京: 人民卫生出版社, 2024. |
| [2] | Suskind, A.M., Cawthon, P.M., Nakagawa, S., Subak, L.L., Reinders, I., Satterfield, S., et al. (2016) Urinary Incontinence in Older Women: The Role of Body Composition and Muscle Strength: From the Health, Aging, and Body Composition Study. Journal of the American Geriatrics Society, 65, 42-50. https://doi.org/10.1111/jgs.14545 |
| [3] | Marques, L.P., Schneider, I.J.C., Giehl, M.W.C., Antes, D.L. and d’Orsi, E. (2015) Demographic, Health Conditions, and Lifestyle Factors Associated with Urinary Incontinence in Elderly from Florianópolis, Santa Catarina, Brazil. Revista Brasileira de Epidemiologia, 18, 595-606. https://doi.org/10.1590/1980-5497201500030006 |
| [4] | Manso, M., Botelho, F., Bulhões, C., Cruz, F. and Pacheco-Figueiredo, L. (2023) Self-Reported Urinary Incontinence in Women Is Higher with Increased Age, Lower Educational Level, Lower Income, Number of Comorbidities, and Impairment of Mental Health. Results of a Large, Population-Based, National Survey in Portugal. World Journal of Urology, 41, 3657-3662. https://doi.org/10.1007/s00345-023-04677-5 |
| [5] | Peinado-Molina, R.A., Hernández-Martínez, A., Martínez-Vázquez, S., Rodríguez-Almagro, J. and Martínez-Galiano, J.M. (2023) Pelvic Floor Dysfunction: Prevalence and Associated Factors. BMC Public Health, 23, Article No. 2005. https://doi.org/10.1186/s12889-023-16901-3 |
| [6] | Sawai, M., Yuno, C., Shogenji, M., Nakada, H., Takeishi, Y., Kawajiri, M., et al. (2022) Prevalence of Symptoms of Pelvic Floor Dysfunction and Related Factors among Japanese Female Healthcare Workers. Lower Urinary Tract Symptoms, 14, 380-386. https://doi.org/10.1111/luts.12455 |
| [7] | Zhang, L., Zhu, L., Xu, T., Lang, J., Li, Z., Gong, J., et al. (2015) A Population-Based Survey of the Prevalence, Potential Risk Factors, and Symptom-Specific Bother of Lower Urinary Tract Symptoms in Adult Chinese Women. European Urology, 68, 97-112. https://doi.org/10.1016/j.eururo.2014.12.012 |
| [8] | 宋楚翘, 朱依萍, 韩邦旻, 等. 压力性尿失禁的危险因素与防治策略[J]. 中华医学杂志, 2022(48): 3811-3814. |
| [9] | Klauser, A., Frauscher, F., Strasser, H., Helweg, G., Kölle, D., Strohmeyer, D., et al. (2004) Age-Related Rhabdosphincter Function in Female Urinary Stress Incontinence. Journal of Ultrasound in Medicine, 23, 631-637. https://doi.org/10.7863/jum.2004.23.5.631 |
| [10] | Lau, H., Su, T. and Huang, W. (2021) Effect of Aging on Lower Urinary Tract Symptoms and Urodynamic Parameters in Women. Taiwanese Journal of Obstetrics and Gynecology, 60, 513-516. https://doi.org/10.1016/j.tjog.2021.03.022 |
| [11] | 王小榕, 石俊霞, 翟桂荣, 等. 孕期及产后妇女发生尿失禁的影响因素[J]. 中华妇产科杂志, 2010, 45(2): 104-108. |
| [12] | Liu, W. and Qian, L. (2024) Risk Factors for Postpartum Stress Urinary Incontinence: A Prospective Study. BMC Urology, 24, Article No. 42. https://doi.org/10.1186/s12894-024-01430-x |
| [13] | 楼叶琳, 胡洋, 周一波, 等. 产后压力性尿失禁风险列线图的建立与验证[J]. 中华泌尿外科杂志, 2021, 42(8): 627-632. |
| [14] | 冯璐珊. 产后压力性尿失禁的康复护理进展综述[J]. 临床医学进展, 2024, 14(4): 239-243. |
| [15] | Townsend, M.K., Danforth, K.N., Rosner, B., Curhan, G.C., Resnick, N.M. and Grodstein, F. (2007) Body Mass Index, Weight Gain, and Incident Urinary Incontinence in Middle-Aged Women. Obstetrics & Gynecology, 110, 346-353. https://doi.org/10.1097/01.aog.0000270121.15510.57 |
| [16] | 应婷, 杨芳华, 王鑫丹, 陶华. 柳州地区成年女性压力性尿失禁患病率及影响因素分析[J]. 中华疾病控制杂志, 2017, 21(8): 860-862. |
| [17] | 宋晓红, 白文佩, 朱兰, 等. 肥胖女性压力性尿失禁体质量管理中国专家共识(2020版) [J]. 实用临床医药杂志, 2020, 24(2): 1-5. |
| [18] | 金鑫悦, 黄锦华, 尤晓凤, 等. 近10年中国成年女性压力性尿失禁患病率及影响因素的Meta分析[J]. 中国疗养医学, 2024, 33(3): 24-29. |
| [19] | Perera, J., Kirthinanda, D.S., Wijeratne, S. and Wickramarachchi, T.K. (2014) Descriptive Cross-Sectional Study on Prevalence, Perceptions, Predisposing Factors and Health Seeking Behaviour of Women with Stress Urinary Incontinence. BMC Women’s Health, 14, Article No. 78. https://doi.org/10.1186/1472-6874-14-78 |
| [20] | Xie, X., Chen, Y., Khan, A., Long, T., Li, S. and Xie, M. (2020) Risk Factors for Urinary Incontinence in Chinese Women: A Cross-Sectional Survey. Female Pelvic Medicine & Reconstructive Surgery, 27, 377-381. https://doi.org/10.1097/spv.0000000000000871 |
| [21] | Wei, D., Meng, J., Zhang, Y., Chen, Y., Li, J. and Niu, X. (2022) Identification of Potential Associated Factors for Stress Urinary Incontinence in Women: A Retrospective Study. Annals of Translational Medicine, 10, 965-965. https://doi.org/10.21037/atm-22-3539 |
| [22] | Pang, H., Lv, J., Xu, T., Li, Z., Gong, J., Liu, Q., et al. (2021) Incidence and Risk Factors of Female Urinary Incontinence: A 4-Year Longitudinal Study among 24 985 Adult Women in China. International Journal of Obstetrics & Gynaecology, 129, 580-589. https://doi.org/10.1111/1471-0528.16936 |
| [23] | 杨存珍, 陈如冲, 李斌恺, 等. 女性慢性咳嗽患者生活质量及尿失禁调查[J]. 国际呼吸杂志, 2010, 30(7): 391-394. |
| [24] | Swenson, C.W., Kolenic, G.E., Trowbridge, E.R., Berger, M.B., Lewicky-Gaupp, C., Margulies, R.U., et al. (2017) Obesity and Stress Urinary Incontinence in Women: Compromised Continence Mechanism or Excess Bladder Pressure during Cough? International Urogynecology Journal, 28, 1377-1385. https://doi.org/10.1007/s00192-017-3279-6 |
| [25] | Brown, J.S., Vittinghoff, E., Lin, F., Nyberg, L.M., Kusek, J.W. and Kanaya, A.M. (2006) Prevalence and Risk Factors for Urinary Incontinence in Women with Type 2 Diabetes and Impaired Fasting Glucose. Diabetes Care, 29, 1307-1312. https://doi.org/10.2337/dc05-2463 |
| [26] | Liu, N., Xing, L., Mao, W., Chen, S., Wu, J., Xu, B., et al. (2021) Relationship between Blood Glucose and Hemoglobin A1c Levels and Urinary Incontinence in Women. International Journal of General Medicine, 14, 4105-4116. https://doi.org/10.2147/ijgm.s324332 |
| [27] | Wang, R., Lefevre, R., Hacker, M.R. and Golen, T.H. (2015) Diabetes, Glycemic Control, and Urinary Incontinence in Women. Female Pelvic Medicine & Reconstructive Surgery, 21, 293-297. https://doi.org/10.1097/spv.0000000000000193 |
| [28] | Lee, W., Wu, H., Tai, T., Liu, S., Chen, J. and Yu, H. (2004) Effects of Diabetes on Female Voiding Behavior. Journal of Urology, 172, 989-992. https://doi.org/10.1097/01.ju.0000136255.83054.0c |
| [29] | Markland, A.D., Vaughan, C.P., Okosun, I.S., Goode, P.S., Burgio, K.L. and Johnson, T.M. (2018) Cluster Analysis of Multiple Chronic Conditions Associated with Urinary Incontinence among Women in the USA. BJU International, 122, 1041-1048. https://doi.org/10.1111/bju.14246 |
| [30] | 薄小杰, 马乐, 杨森. 循证视角下成年女性压力性尿失禁发病风险的Rothman-Keller模型构建研究[J]. 中国全科医学, 2021, 24(30): 3893-3899. |
| [31] | Aune, D., Mahamat-Saleh, Y., Norat, T. and Riboli, E. (2019) Body Mass Index, Abdominal Fatness, Weight Gain and the Risk of Urinary Incontinence: A Systematic Review and Dose-Response Meta-Analysis of Prospective Studies. International Journal of Obstetrics & Gynaecology, 126, 1424-1433. https://doi.org/10.1111/1471-0528.15897 |
| [32] | 王华菊, 叶润英, 黎小斌. 盆腔器官脱垂传统术式术后尿失禁的相关因素分析及围手术期中医药治疗探讨[J]. 广州中医药大学学报, 2021, 38(11): 2318-2322. |
| [33] | Altman, D., Granath, F., Cnattingius, S. and Falconer, C. (2007) Hysterectomy and Risk of Stress-Urinary-Incontinence Surgery: Nationwide Cohort Study. The Lancet, 370, 1494-1499. https://doi.org/10.1016/s0140-6736(07)61635-3 |
| [34] | 陈雅囡, 石荟莲, 郭方书. 老年子宫脱垂患者术后新发压力性尿失禁情况及其影响因素分析[J]. 中华保健医学杂志, 2024, 26(4): 488-490. |
| [35] | 汪莎, 汪海波, 孙秀丽, 等. 开腹和腹腔镜广泛子宫切除术对宫颈癌患者盆底功能及生活质量影响的比较[J]. 现代妇产科进展, 2021, 30(7): 503-507. |
| [36] | Schimpf, M.O., O’Sullivan, D.M., LaSala, C.A. and Tulikangas, P.K. (2006) Anterior Vaginal Wall Prolapse and Voiding Dysfunction in Urogynecology Patients. International Urogynecology Journal, 18, 721-725. https://doi.org/10.1007/s00192-006-0227-2 |
| [37] | 应婷, 王鑫丹, 陶华. 柳州地区女性盆腔脏器脱垂与压力性尿失禁之间的关系[J]. 中国临床新医学, 2017, 10(9): 850-853. |
| [38] | 张永秀, 周有芬. 子宫脱垂病人合并压力性尿失禁的超声研究[C]//北京协和医院. 第一届全国女性尿失禁与盆底功能障碍学术会论文集. 北京: 中华妇产科杂志, 2004: 81-84. |
