神经源性下尿路功能障碍（neurogenic   lower urinary  tract  dysfunction ，NLUTD）是一类由神经系统病变导致膀胱和（或）尿道功能障碍产生的一系列并发症的疾病总称。目前，对于该疾病的诊断与监测主要基于侵入性尿流动力学检查。有研究发现，一些尿源性生物标志物在NLUTD患者的尿液中升高，例如神经生长因子、前列腺素、炎性细胞因子、中性粒细胞明胶酶相关脂质运载蛋白、参与细胞外基质降解的蛋白质等。这些尿源性生物标志物作为一种非侵入性的监测方法或许可以为该疾病的诊断与监测带来突破，并进一步成为尿动力学检查的一种微创替代方法。基于此，本文总结了多种用于NLUTD及其并发症诊断与监测的尿液生物标志物，并分析目前的研究进展。

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孙朋浩,宋伟.神经源性下尿路功能障碍中尿源性生物标志物的研究进展[J].泌尿外科杂志(电子版),2024,16(01):54-58.DOI:10.20020/j.CNKI.1674-7410.2024.01.12.

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神经源性下尿路功能障碍（neurogenic  lower urinary tract  dysfunction ，NLUTD）是一类由神经系统病变导致膀胱和（或）尿道功能障碍产生的一系列并发症的疾病总称[1]。国际尿失禁学会将NLUTD定义为在临床确认的相关神经系统疾病背景下，成人膀胱、尿道和（或）男性前列腺功能异常[2]。目前，该疾病通常需要在中枢或周围神经病变的前提下才可诊断。所有可能累及储尿和（或）排尿生理调节过程的神经系统病变如脊髓损伤、周围神经病变等，都有可能引起NLUTD。NLUTD临床表现可能与神经损伤位置及程度存在一定相关性。NLUTD会引起多种并发症，最常见的是反复发作的尿路感染（urinary tract infection，  UTI）、肾盂肾炎，还会有肾积水、肾功能衰竭等严重的不可逆性上尿路损伤[3]。有研究证实，脊髓损伤患者首要致死原因是肾功能衰竭[3-4]。因此，NLUTD患者需要终身监测和管理，以提高生活质量并预防发生严重并发症。NLUTD及其并发症的早期诊断和客观评估非常重要，早期诊断与治疗可有效避免不可逆性尿路病变的产生与进展，对提高及预后患者生活质量至关重要。目前，对于NLUTD的诊断主要基于尿动力学检查。然而，尿动力学检查具有侵入性，且检查价格昂贵、耗时，易引起下尿路损伤及尿路感染[5]。因此，找到非侵入性的诊断或筛查工具来准确诊断、监测NLUTD及其并发症尤为重要。尿液是生物标志物分析中的一种重要生物液体，因其可轻松、非侵入性地大量获得，且存在多种蛋白质、细胞和生物化学物质等优点，被广泛研究应用。尿液标志物被认为是诊断神经源性和非神经源性下尿路功能障碍的一种有前景和潜力的工具，有助于阐明疾病复杂的病理、生理，成为尿动力学检查的一种微创替代方法。本文总结多种用于NLUTD及其并发症诊断与监测的尿液生物标志物，且分析目前研究进展。

1 神经生长因子

2 前列腺素 E2

3 炎性细胞因子

4 中性粒细胞明胶酶相关脂质运载蛋白

5 参与细胞外基质降解的蛋白质

6 展望

NLUTD患者临床表现为储尿、排尿障碍或两者兼有，如尿频、尿急、排尿困难及尿失禁等，并存在多种并发症。现如今NLUTD的诊断与监测仍基于尿动力学检查。随着研究的深入，越来越多的尿源性生物标志物在NLUTD患者尿液中的变化被发现，因其获取简便，且具有敏感性和无创性等优势，为该疾病的诊疗提供了新思路。然而，目前所了解的尿液生物标志物仍存在许多矛盾的结果或缺乏有力的证据。尿液生物标志物对于NLUTD诊断与监测的研究仍处于起步阶段，但其成为诊断与监测NLUTD及其并发症的潜力不能被否定。因此，需要进一步研究来详细说明每个标志物在NLUTD诊断与监测中的效用。随着研究的深入与技术的进步，相信尿源性生物标志物可为NLUTD的诊断与监测开辟新的道路。

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