四联药物与透明质酸钠膀胱灌注治疗间质性膀胱炎/膀胱疼痛综合征的疗效比较  

Efficacy comparison of interstitial cystitis/painful bladder syndrome patients treated with four-drug combination and sodium hyaluronate intravesical instillation

作　　者：方志伟[1] 张晓鹏[1] 胡浩[1] 许克新[1] 黄晓波[1] 王晓峰[1] 

机构地区：[1]北京大学人民医院泌尿外科,100044

出　　处：《中华泌尿外科杂志》2015年第4期280-284,共5页Chinese Journal of Urology

摘　　要：目的 评估肝素＋利多卡因＋碳酸氢钠＋庆大霉素四联药物与透明质酸钠膀胱灌注治疗间质性膀胱炎/膀胱疼痛综合征（interstitial cystitis/painful bladder syndrome,IC/PBS）的疗效差别.方法 回顾性研究我科首诊的23例IC/PBS患者资料.四联药物组（4万单位肝素、10 ml 2％利多卡因、10 ml 5％碳酸氢钠、16万单位庆大霉素加生理盐水配成50 ml）10例为A组,透明质酸钠组（40 mg/50 ml） 13例为B组.确诊后A组每周灌注2次,灌注6～8周;之后每月2次,灌注10个月.B组每周灌注1次,灌注6～8周;之后每月1次,灌注10个月.灌注液保留1h后排出,分别于治疗前及治疗后1、6、12个月行O＇Leary-Sant评分,记录排尿日记与灌注不良反应.结果 22例随访至12个月,B组1例因反复泌尿系感染而中断治疗.两组患者治疗前年龄、病程、IC症状评分、IC问题评分、日排尿次数、最大膀胱容量比较差异均无统计学意义（P＞0.05）.A组患者无不良反应,B组2例灌注后膀胱区疼痛加重.两组患者经过膀胱灌注治疗1、6、12个月后,IC症状评分、IC问题评分、日排尿次数、最大膀胱容量均有改善,且A、B组所有指标与治疗前相比改善均有统计学意义（P＜0.05）.以O＇Leary-Sant症状评分下降≥25％或者日排尿次数下降≥25％为症状缓解,两组治疗后1个月（100％和100％,P=1.000）、6个月（80％和83％,P=1.000）、12个月（70％和75％,P=1.000）缓解率比较差异均无统计学意义.结论 以肝素为核心的四联药物与透明质酸钠膀胱灌注治疗IC/PBS的疗效相似.Objective To compare the outcomes between interstitial cystitis/painful bladder syndrome （IC/PBS） patients treated with four-drug combination （heparin,lidocaine,sodium bicarbonate,gentamicin） and sodium hyaluronate intravesical instillation.Methods There were 23 IC/PBS patients from Jan.1,2011 to Mar.1,2013.Ten patients （group A） received four-drug combination （heparin 40 000 U,＇gentamicin 160 000 U,sodium bicarbonate 1%,lidocaine 0.4%） instillation treatment.Thirteen patients received instillation of sodium hyaluronate （40 mg/50 ml） therapy （group B）.In group B,intravesical instillations were performed weekly in the first 6-8 weeks,and monthly until one year.Patients in group A received intravesical instillation twice a week in the first 6-8 weeks and twice a month for 10 months.All the patients were instructed to retain the instillation volume for at least one hour.Clinical symptoms （24 h frequency of urination,maximal micturition volume）,O＇Leary-Sant symptom and problem index were assessed at baseline and 1,6 and 12 months after treatment.The 2 therapies were compared within curative effects and side effects.Results Twenty-two of the 23 patients were followed up to 12 months.Patients in group A had no adverse events reported.One case of group B dropped out from treatment for recurrent urinary tract infection,and the other two cases felt painful in bladder area during instillation.There was no significant difference in initial scores between the 2 groups （P〉0.05）.At 1,6,12 months after intravesical instillation,interstitial cystitis symptom index,interstitial cystitis problem index,24 h frequency of urination,the maximum bladder capacity were improved in both groups.All indicators in group A and B were improved significantly after treatment compared with pretreatment （P 〈 0.05）.≥ 25% decrease of interstitial cystitis symptom index or ≥25% decrease of 24 h frequency of urination were defined as remission.Remission rates of the 2 groups at each time point were：1 m

关 键 词：间质性膀胱炎/膀胱疼痛综合征 四联药物 透明质酸钠 膀胱灌注 

分 类 号：R694.3[医药卫生—泌尿科学]