富血小板血浆治疗间质性膀胱炎/膀胱疼痛综合征的有效性和安全性  

The efficacy and safety of platelet-rich plasma in treating interstitial cystitis/bladder pain syndrome

作　　者：郑强平 张蕾[2] 张建忠[1] 刘赛[1] 张帆[2] 张鹏[1] Zheng Qiangping;Zhang Lei;Zhang Jianzhong;Liu Sai;Zhang Fan;Zhang Peng(Department of Urology,Beijing Chaoyang Hospital,Capital Medical University,Bejing 100020,China;Department of Blood Transfusion,Beijing Chaoyang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科,北京100020 [2]首都医科大学附属北京朝阳医院输血科,北京100020

出　　处：《中华泌尿外科杂志》2024年第10期745-750,共6页Chinese Journal of Urology

摘　　要：目的探讨富血小板血浆(PRP)治疗间质性膀胱炎/膀胱疼痛综合征(IC/BPS)的疗效和安全性。方法去本研究前瞻性纳入2023年1月至2024年4月于北京朝阳医院确诊为IC/BPS并接受多次PRP注射治疗的患者。纳人标准:①年龄>18岁;②有尿频、尿急、尿痛、盆腔疼痛等症状;③既往行麻醉下膀胱镜水扩张确诊为非溃疡型IC/BPS;④尿动力学、影像学等检查排除其他疾病;⑤既往接受过>3种治疗,包括但不限于生活方式改变、透明质酸膀胱灌注、肉毒毒素膀胱壁注射、膀胱镜下水扩张等,但症状未改善;⑥签署相关操作知情同意书。排除标准:①处于泌尿系感染活动期;②正在使用抗凝剂或抗血小板药物;③导致全身免疫性疾病的T淋巴细胞瘤;④血小板计数<100×10^(9)/L,血红蛋白<100g/L;⑤有严重心脑血管疾病;⑥有无法接受血小板单采的其他疾病。每例患者通过血细胞分离机采集约100mlPRP后,选取1ml检测血小板,其余PRP分装为6袋,每袋约15ml。每个月接受1次PRP注射,共6次。每次取1袋PRP,于膀胱镜可见视野下在膀胱壁上均匀选择30个位点注射,每个位点注射0.5ml。主要评估终点为整体反应评估(CRA),于每次术后1个月进行,CRA≥5分定义为改善,≥6分定义为效果良好。术前和每次术后1个月评估24h排尿次数、夜尿次数、功能膀胱容量、O'Leary-sant评分[包括间质性膀胱炎症状评分(IC-SI)和间质性膀胱炎问题指数(IC-PI)]、盆腔疼痛与尿频尿急(PUF)评分、疼痛视觉模拟量表(VAS)评分、生活质量(QOL)评分。结果本研究共纳人21例患者,男2例,女19例。年龄(37.10±14.75)岁。术前病程为(4.05±3.25)年。术前全麻下膀胱容量(502.86±150.84)ml。21例中,11例完成6次注射,6例完成5次注射,4例完成4次注射。经4次注射后,GRA≥5分17例,≥6分11例,改善率为80.95%。完成最后1次注射后,GRA≥5分18例,≥6分12例,总体改善率为85.71%。21例术前和�Objective To investigate the efficacy and safety of platelet-rich plasma(PRP)in the treatment of interstitial cystitis/bladder pain syndrome(IC/BPS).Methods This prospective study included patients diagnosed with IC/BPS who received multiple PRP injections at our hospital from January 2023,to April 2024.Inclusion criteria included patients over 18 years old with symptoms of urinary frequency,urgency,pain,and pelvic pain,patients who were required to have confirmed non-ulcerative IC/BPS via cystoscopic hydrodistension under anesthesia and exclusion of other diseases through urodynamic and imaging tests,patients who failed to improve after more than three treatments including lifestyle intervention,intravesical hyaluronic acid instillation,botulinum toxin injection,or cystoscopic hydrodistension,and they all signed sign informed consent for the procedures.Exclusion criteria included active urinary tract infection,use of anticoagulants or antiplatelet drugs,T-cell lymphoma causing systemic autoimmune disease,platelet count below 100×10^(9)/L,hemoglobin level below 100 g/L,severe cardiovascular disease,or other conditions that preclude platelet apheresis.Approximately 100 ml of PRP was collected from each patient using a blood cell separator,with 1 ml reserved for platelet detection and the remaining PRP divided into six bags,each containing about 15 ml.Patients received one PRP injection per month,for a total of six injections.Each injection involved 30 evenly distributed sites on the bladder wall under cystoscopic visualization,with O.5 ml injected per site.The primary endpoint was global response assessment(GRA),conducted approximately one month after each procedure,with CRA≥5 indicating improvement and GRA≥6 indicating good efficacy.Secondary endpoints included assessments of 24-hour urinary frequency,nocturia,functional bladder capacity,OLeary-Sant scores[including the IC Symptom Index(IC-SI)and IC Problem Index(IC-PI)J,pelvic pain and urgency/frequency(PUF)scores,visual analogue scale(VAS)for pain,and qual

关 键 词：富血小板血浆 间质性膀胱炎/膀胱疼痛综合征 膀胱注射 

分 类 号：R694.3[医药卫生—泌尿科学]