Panoramic analysis of influencing factors and their mechanisms of action in elderly lower urinary tract symptoms

doi:10.3877/cma.j.issn.2095-3216.2025.06.005

Abstract

Abstract:

Screening and intervention for the influencing factors of lower urinary tract symptoms (LUTS) in their early stages play a crucial role in the prevention and treatment of LUTS. This article provided a comprehensive review of the epidemiology, influencing factors, and their mechanisms in LUTS of the elderly. Additionally, the limitations and contradictions of previous LUTS studies as well as future research directions were discussed.

Key words: Lower urinary tract symptoms, Elderly, Influencing factors, Clinical management

Xinyan Gong, Xiang Yu, Yuwei Ji, Baolong Wang, Weiguang Zhang, Zhe Feng. Panoramic analysis of influencing factors and their mechanisms of action in elderly lower urinary tract symptoms[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2025, 14(06): 331-338.

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References 80

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推荐等级	证据等级	证据类型
A	1a	同质随机对照试验的系统综述
	1b	单一随机对照试验(可信区间较窄)
	1c	全或无(治疗前所有患者均死亡或部分死亡，治疗后仅部分死亡或全部存活)
B	2a	同质队列研究的系统综述
	2b	单一队列研究和低质量的随机对照研究
	2c	结局研究：生态学研究
	3a	同质病例对照研究的系统综述
	3b	单一病例对照研究
C	4	病例系列(低质量的队列研究和病例对照研究)
D	5	没有严格评价的专家意见或完全基于基础研究

推荐等级	证据等级	证据类型
A	1a	同质随机对照试验的系统综述
	1b	单一随机对照试验(可信区间较窄)
	1c	全或无(治疗前所有患者均死亡或部分死亡，治疗后仅部分死亡或全部存活)
B	2a	同质队列研究的系统综述
	2b	单一队列研究和低质量的随机对照研究
	2c	结局研究：生态学研究
	3a	同质病例对照研究的系统综述
	3b	单一病例对照研究
C	4	病例系列(低质量的队列研究和病例对照研究)
D	5	没有严格评价的专家意见或完全基于基础研究

类别	影响因素内容	证据等级	推荐等级	主要机制	参考文献
人口学因素	年龄	1b	A	泌尿系结构解剖和功能退行性变	[14，15]
	性别	1b	A	生理和激素环境的根本不同	[16，17]
	遗传	2a	B	致病机制和药理学机制的高度异质性	[22]
行为与环境暴露	环境污染物	2b	B	氧化应激和全身炎症反应引发代谢综合征	[28，29]
	促炎饮食	2b	B	增加全身炎症	[30，33]
	盆底结构损伤	1b	A	盆底结构完整性破坏引发盆底功能障碍	[35，36，37，38，39]
	睡眠障碍	2b	B	代谢-激素失衡、昼夜节律紊乱、慢性炎症、动脉粥样硬	[40，41，42]
慢性疾病和代谢	心血管疾病	2b	B	缺血、慢性炎症	[43，44，45]
	代谢综合征	2b	B	高免疫炎症水平、激素变化、氧化应激、动脉粥样硬化	[47，48，49，50，51，52]
	痴呆	2b	B	不仅涉及痴呆或行动不便，还涉及中枢和外周的躯体-自主神经功能障碍	[53，54，55]
	脑卒中	2b	B	可能与中风后膀胱的神经支配与与高级大脑中枢的连接丧失有关	[56]
	虚弱	2b	B	限制身体活动；肌肉减少症作为虚弱发展关键介导下尿路症状	[53，57，58，59，60]
	心理困扰	1a	A	释放促炎细胞因子和趋化因子作用于神经系统和膀胱局部	[61，62，63，64]
	前列腺增生	1a	A	除机械性压迫外，前列腺和膀胱颈部平滑肌张力增高尿流阻力增加	[65，66，67，68]
	手术	1a	A	术后创伤形成的瘢痕、术中对括约肌的牵拉压迫，以及膀胱挛缩等均是常见且主要原因	[69，70]
	泌尿系感染	4	C	细菌容易进入尿路、细菌冲洗受损和先天防御系统受损	[72]
药物	利尿剂	2b	B	促进水钠排泄	[74]
	钙通道阻滞剂	2b	B	影响膀胱和/或前列腺功能；引起外周水肿	[75]
	他汀类药物	2b	B	不明确	[76]
其他	高钙尿症	2b	B	抗利尿激素减少引起尿液浓缩障碍，尿钠排泄增加引发渗透性利尿	[79]
	口腔虚弱	2b	B	食物摄入量减少进而引起虚弱	[80]

类别	影响因素内容	证据等级	推荐等级	主要机制	参考文献
人口学因素	年龄	1b	A	泌尿系结构解剖和功能退行性变	[14，15]
	性别	1b	A	生理和激素环境的根本不同	[16，17]
	遗传	2a	B	致病机制和药理学机制的高度异质性	[22]
行为与环境暴露	环境污染物	2b	B	氧化应激和全身炎症反应引发代谢综合征	[28，29]
	促炎饮食	2b	B	增加全身炎症	[30，33]
	盆底结构损伤	1b	A	盆底结构完整性破坏引发盆底功能障碍	[35，36，37，38，39]
	睡眠障碍	2b	B	代谢-激素失衡、昼夜节律紊乱、慢性炎症、动脉粥样硬	[40，41，42]
慢性疾病和代谢	心血管疾病	2b	B	缺血、慢性炎症	[43，44，45]
	代谢综合征	2b	B	高免疫炎症水平、激素变化、氧化应激、动脉粥样硬化	[47，48，49，50，51，52]
	痴呆	2b	B	不仅涉及痴呆或行动不便，还涉及中枢和外周的躯体-自主神经功能障碍	[53，54，55]
	脑卒中	2b	B	可能与中风后膀胱的神经支配与与高级大脑中枢的连接丧失有关	[56]
	虚弱	2b	B	限制身体活动；肌肉减少症作为虚弱发展关键介导下尿路症状	[53，57，58，59，60]
	心理困扰	1a	A	释放促炎细胞因子和趋化因子作用于神经系统和膀胱局部	[61，62，63，64]
	前列腺增生	1a	A	除机械性压迫外，前列腺和膀胱颈部平滑肌张力增高尿流阻力增加	[65，66，67，68]
	手术	1a	A	术后创伤形成的瘢痕、术中对括约肌的牵拉压迫，以及膀胱挛缩等均是常见且主要原因	[69，70]
	泌尿系感染	4	C	细菌容易进入尿路、细菌冲洗受损和先天防御系统受损	[72]
药物	利尿剂	2b	B	促进水钠排泄	[74]
	钙通道阻滞剂	2b	B	影响膀胱和/或前列腺功能；引起外周水肿	[75]
	他汀类药物	2b	B	不明确	[76]
其他	高钙尿症	2b	B	抗利尿激素减少引起尿液浓缩障碍，尿钠排泄增加引发渗透性利尿	[79]
	口腔虚弱	2b	B	食物摄入量减少进而引起虚弱	[80]

类别	影响因素内容	支持关联的证据	反对关联的证据
人口学因素	种族	Abimbola等^[17]认为种族与前列腺增生独立相关	Brady等^[18,19]认为根本原因是社会认同和社会经济地位
	离婚或丧偶、低收入、受教育水平低、失业等社会因素	Hamshari等^[21]研究证明是老年高血压患者LUTS的影响因素	Xiong等^[22]在中国老年BPH患者中未观察到婚姻状况对LUTS/BPH的任何影响
行为与环境暴露	吸烟和饮酒	Jeong等^[24,25]认为累积吸烟量与LUTS显著相关	Mou等^[22]认为吸烟是LUTS的保护因素
		Takahashi等^[27]认为所有饮酒者LUTS风险均增加	Yang等^[21]认为适度和重度饮酒都对LUTS起到保护作用；Riccardo等^[26]未发现酒精摄入与LUTS的显著相关性
	身体活动不足	Cai等^[31]认为提高神经兴奋性和炎症水平可引起LUTS^[30]；Oppert等认为长期引起或加重肥胖导致LUTS	Mutlu等^[32]一项前瞻性观察研究结果显示增加身体运动导致白天、夜间和24h内利尿显著增加
药物	中药	Wang等^[73]认为中药可减轻前列腺增生严重程度改善LUTS	Mou等^[13]认为中药与LUTS患病率增加相关性较强
	维生素D缺乏	Jeong等^[77]认为补充维生素D可抑制前列腺体积的增加并改善男性LUTS	Serin等^[78]未发现维生素D缺乏与女性LUTS之间的相关性
其他	肠道微生物群失调	Cai等^[30]认为可通过胰岛素抵抗和其他代谢紊乱参与BPH/LUTS的发展	目前缺乏高质量的人群研究证据证实其因果关系

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