肉毒素A联合透明质酸钠治疗间质性膀胱炎的疗效观察

摘要

Objectives To evaluate the efficacy and safety of intravesical botulinum toxin A (BTX-A) injections and instillation of sodium hyaluronate therapy for the treatment of interstitial cystitis/ painful bladder syndrome(IC/PBS).Methods In the 53 patients with IC/PBS,28 patients received intravesical BTX-A injections and instillation of sodium hyaluronate therapy (group A),and the other 25 patients were given instillation of sodium hyaluronate therapy (group B).Clinical symptoms (micturition frequency per day,maximal micturition volume and odynuria degree score),O Leary-Sant symptom and problem index were assessed at baseline and then after 2 weeks,1,2 and 6months.Results Before and after therapy,clinical symptoms,O 'Leary-Sant symptom and problem index of group A had significant differences (P ＜ 0.05).Before and after 2 weeks,clinical symptoms,O 'Leary-Sant symptom and problem index of group B had no significant differences (P ＞ 0.05).But at various points,clinical symptoms,O 'Leary-Sant symptom and problem index of group B had significant differences (P ＜ 0.05).After treatment,the result of therapeutic effect evaluation in the two groups had significant differences (P ＜ 0.05).There were three patients who got urinary tract infection,and no other side effects.Conclusions Intravesical BTX-A injections and instillation of sodium hyaluronate therapy can rapidly and effectively relieve clinical symptom of IC/PBS.It can better improve lower abdominal pain,excessive urination at night,and urinary frequency,and impove patients'quality of life,and provide a new effctive therapy for IC/PBS.%目的 探讨肉毒素A膀胱内注射联合透明质酸钠膀胱灌注治疗间质性膀胱炎(IC/PBS)的有效性和安全性.方法 53例IC/PBS患者,其中行肉毒素A膀胱内注射联合透明质酸钠膀胱灌注28例(A组),单纯行透明质酸钠膀胱灌注25例(B组).观察并记录患者治疗前及治疗2周、1、3、6个月的临床症状(每日排尿次数、最大排尿容量、VAS疼痛评分)和O'Leary-Sant IC问卷表评分情况,治疗完成后进行疗效评估,并记录不良反应发生情况.结果 A组患者治疗各时间点的每日排尿次数、最大排尿容量、VAS疼痛评分、O' Leary-Sant评分与治疗前相比差异均有统计学意义(P＜0.05);B组患者治疗2周和治疗前比较差异无统计学意义(P＞0.05),其余治疗的各时间点和治疗前比较均有统计学意义(P＜0.05).治疗完成后,两组患者下腹酸胀/疼痛改善率分别为82.1％ (23/28)和68.0％(17/25),夜尿次数多改善率分别为78,6％(22/28)和64.0％ (16/25),尿频尿急改善分别为60.1％ (17/28)和28.0％(7/25),组间疗效评估结果差异均有统计学意义(P ＜0.05,其中尿频尿急改善率差异P＜0.01).A、B两组各有5例在膀胱灌注后出现尿路感染,口服抗生素后缓解.所有患者均完成治疗及随访.结论 肉毒素A膀胱内注射联合透明质酸钠膀胱灌注治疗IC/PBS能够迅速有效的缓解患者临床症状,较单纯透明质酸灌注能更好地改善IC/PBS所造成的下腹酸胀/疼痛、夜尿次数多和尿频尿急,提高患者生活质量,为治疗IC/PBS提供了一种新的有效方法.