The overactive bladder: Pharmacologic basis of drug treatment
The overactive bladder: Pharmacologic basis of drug treatment
复制标题
DOI：
10.1016/s0090-4295(97)00595-5
复制
发表时间：
1997-12-01
期刊：
影响因子：
2.1
通讯作者：
Andersson, KE
中科院分区：
文献类型：
--
作者：
Andersson, KE
目标。概述膀胱过度活动症药物治疗的基础。方法。公布的信息是经过评估的结果。膀胱过度活动的原因尚不清楚，但理论上可能与传入活动增加、中枢神经系统（CNS）或周围神经节抑制控制降低以及逼尿肌对传出刺激的敏感性增加有关。几种中枢神经系统递质可以调节排尿，但很少有具有明确中枢神经系统作用位点的有用药物被开发出来。临床上使用刺激γ-氨基丁酸受体的药物。可以开发影响阿片类药物、5-羟色胺、去甲肾上腺素、多巴胺和谷氨酸受体和机制的药物，但可能难以获得对下尿路的选择性作用。传统上，用于治疗膀胱过度活动的药物具有外周作用部位，主要是传出神经传递或逼尿肌本身。抗毒蕈碱药物、β-肾上腺素受体激动剂、α-肾上腺素受体拮抗剂、影响膜通道的药物、前列腺素合成酶抑制剂和其他几种药物已被使用，但取得了有限的成功。关于人类逼尿肌中α-肾上腺素受体和毒蕈碱受体亚型的新信息已经出现，这可能是开发对膀胱过度活动有效的新化合物的基础。减少传入活动似乎是一种有吸引力的治疗方法，通过引起速激肽释放而影响传入神经的药物，例如辣椒素和类似物，以及阻断速激肽受体的药物，可能具有治疗意义。结论。专门为治疗膀胱过度活动而设计的新药是可取的。 (C) 1997，Elsevier Science Inc. 保留所有权利。
Objectives. To provide an overview of the basis for drug treatment of the overactive bladder.Methods. Published information is evaluated.Results. The causes of bladder overactivity are not known, but theoretically, increased afferent activity, decreased inhibitory control in the central nervous system (CNS) or peripheral ganglia, and increased sensitivity of the detrusor to efferent stimulation may be involved. Several CNS transmitters can modulate voiding, but few useful drugs with a defined CNS site of action have been developed. Drugs that stimulate gamma-aminobutyric acid receptors are used clinically. Potentially, drugs affecting opioid, 5-hydroxytryptamine, norepinephrine, dopamine, and glutamatergic receptors and mechanisms can be developed, but a selective action on the lower urinary tract may be difficult to obtain. Traditionally, drugs used for treatment of bladder overactivity have had a peripheral site of action, mainly efferent neurotransmission or the detrusor itself. Antimuscarinic drugs, beta-adrenoceptor agonists, alpha-adrenoceptor antagonists, drugs affecting membrane channels, prostaglandin synthetase inhibitors, and several other agents have been used with limited success. New information on the alpha-adrenoceptor and muscarinic receptor subtypes in the human detrusor has emerged and may be the basis for the development of new compounds with effects on bladder overactivity. Decreasing afferent activity seems an attractive therapeutic approach, and drugs affecting afferent nerves by causing release of tachykinins, such as capsaicin and analogs, as well as agents blocking tachykinin receptors, may be of therapeutic interst.Conclusions. New drugs, specifically designed for the treatment of bladder overactivity, are desirable. (C) 1997, Elsevier Science Inc. All rights reserved.