Afferent nerve regulation of bladder function in health and disease.
Afferent nerve regulation of bladder function in health and disease.
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DOI：
10.1007/978-3-540-79090-7_4
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发表时间：
2009
影响因子：
--
通讯作者：
Yoshimura, Naoki
中科院分区：
文献类型：
--
作者：
de Groat, William C;Yoshimura, Naoki
膀胱的传入神经支配主要由响应化学和机械刺激的小的有髓（Aδ）和无髓（C-纤维）轴突组成。免疫化学研究表明，膀胱传入神经元合成几种假定的神经递质，包括神经肽，谷氨酸，天冬氨酸和一氧化氮。传入神经元还表达各种类型的受体和离子通道，包括瞬时受体电位通道、嘌呤能、毒蕈碱、内皮素、神经营养因子和雌激素受体。在分离的膀胱传入神经元和记录膀胱传入神经活动的膜片钳记录显示，许多这些受体的激活增强神经元的兴奋性。传入神经可以对存在于尿液中的化学物质以及从神经、平滑肌、炎性细胞和衬在膀胱腔的上皮细胞释放到膀胱壁中的化学物质做出反应。病理状态改变膀胱传入通路的化学和电性质，导致尿急、排尿频率增加、排尿困难、尿失禁和疼痛。神经营养因子与膀胱传入神经致敏的病理生理机制有关。靶向感觉神经的神经毒素如辣椒素、树脂毒素和肉毒杆菌神经毒素可用于治疗下泌尿道疾病。
The afferent innervation of the urinary bladder consists primarily of small myelinated (Aδ) and unmyelinated (C-fiber) axons that respond to chemical and mechanical stimuli. Immunochemical studies indicate that bladder afferent neurons synthesize several putative neurotransmitters, including neuropeptides, glutamic acid, aspartic acid, and nitric oxide. The afferent neurons also express various types of receptors and ion channels, including transient receptor potential channels, purinergic, muscarinic, endothelin, neurotrophic factor, and estrogen receptors. Patch-clamp recordings in dissociated bladder afferent neurons and recordings of bladder afferent nerve activity have revealed that activation of many of these receptors enhances neuronal excitability. Afferent nerves can respond to chemicals present in urine as well as chemicals released in the bladder wall from nerves, smooth muscle, inflammatory cells, and epithelial cells lining the bladder lumen. Pathological conditions alter the chemical and electrical properties of bladder afferent pathways, leading to urinary urgency, increased voiding frequency, nocturia, urinary incontinence, and pain. Neurotrophic factors have been implicated in the pathophysiological mechanisms underlying the sensitization of bladder afferent nerves. Neurotoxins such as capsaicin, resiniferatoxin, and botulinum neurotoxin that target sensory nerves are useful in treating disorders of the lower urinary tract.