窄带成像膀胱镜诊断间质性膀胱炎的应用

摘要

目的：评估窄带成像（narrow-band imaging， NBI）膀胱镜在诊断间质性膀胱炎（interstitial cystitis， IC）中的应用价值。方法2009年9月至2014年3月，将来海军总医院就诊的65例被高度怀疑为IC的患者纳入研究。首先由1名高年资泌尿外科医师行腰椎麻醉下传统白光（ WLI）模式镜检；接着由另1名低年资泌尿外科医师独立行NBI模式镜检。随后，由以上2名医师共同在行水扩张试验后WLI模式下镜检，并对患者膀胱黏膜异常区域进行活检。结果65例患者中，水扩张试验前行WLI镜检，5例可见溃疡性病变，23例可见非溃疡性毛细血管丰富区；水扩张试验前行NBI镜检，28例WLI镜检阳性者均被检出，另有31例WLI镜检阴性者被发现存在非溃疡性毛细血管丰富区。水扩张试验后行WLI镜检，5例溃疡性病变者可见溃疡处黏膜破裂出血，所有NBI镜检非溃疡性毛细血管丰富区阳性者（54例）及2例NBI镜检阴性者可观察到多处点状出血和肾小球样红斑。61例膀胱黏膜异常者行活检，59例为慢性炎症，2例为原位癌。由此确诊IC共59例。水扩张试验前，WLI镜检诊断IC的敏感度、特异度和Kappa指数分别为44．1％、66．7％、0．032；而NBI镜检诊断IC的敏感度、特异度和Kappa指数分别为96．6％、66．7％、0．633。结论与WLI膀胱镜比较，NBI膀胱镜在水扩张试验前诊断IC敏感度更高，其镜检阳性区域同水扩张试验后阳性区域高度一致，对IC的诊断有较高应用价值。%Objective To investigate the value of narrow-band imaging (NBI) cystoscopy in the diagnosis of interstitial cysti-tis (IC).Methods From Sep.2009 to Mar.2014, 65 patients highly suspected of having IC were included in the study .First, con-ventional white-light imaging(WLI)cystoscopy was performed under spinal anesthesia by a senior urologist .Then, NBI cystoscopy was conducted independently by a junior urologist .Following hydro-distention test , the above two urologists made conventional observation by WLI cystoscopy , and biopsy was performed to see if abnormal bladder mucosa could be detected .Results Conventional WLI cysto-scopy before hydrodistention revealed that 5 patients out of 65 had ulcerative pathological lesion and 23 patients had non-ulcerative capil-lary-rich area .When NBI cystoscopy was administered , 28 WLI-positive cases were detected , and another 31 WLI-negative cases were found to have non-ulcerative capillary-rich area.WLI cystoscopy after hydrodistention revealed that 5 cases with ulcerative lesion had mucosa rupture with bleeding at the site of ulcer , and all the 54 cases with non-ulcerative capillary-rich area under NBI cystoscopy and 2 NBI-negative cases were found to have petechial hemorrhage and glomerulus -like erythema.Biopsies performed in 61 cases with ab-normal bladder mucosa revealed that 59 cases had chronic inflammation and 2 cases were diagnosed to be carcinoma in situ .Thus, 59 were confirmed to be IC cases.In the diagnosis of IC under the WLI mode before hydrodistention , the sensitivity, specificity and Kappa values were 44.1%, 66.7% and 0.032 respectively, while under NBI mode, the sensitivity, specificity and Kappa values were 96.6%, 66.7%and 0.633 respectively.Conclusion Compared with WLI cystoscopy, NBI cystoscopy seemed to be more sensitive in the diagnosis of IC before hydrodistention .The NBI-positive area was highly identical to the positive area after hydrodistention .It had good application value in IC diagnosis .