Current Therapeutic Advances in Chronic Interstitial Cystitis

慢性間質性膀胱炎最新治療方法

郭漢崇(Hann-Chorng Kuo)

《慈濟醫學雜誌》 18卷3期 (2006/06) Pp. 167-174

https://doi.org/10.6440/TZUCMJ.200606.0167

摘要

間質性膀胱炎是以膀胱疼痛伴隨著頻尿、急尿、夜尿、排尿困難等下尿路症狀，而且具有無菌性尿液分析之結果為特徵。對於這個疾病的診斷至今仍然未明，而且主要是以排除其他疾病為診斷之依據。間質性膀胱炎可能的生成原因為：一、感染後之自體免疫反應，二、巨大細胞經由局部發炎、毒物或是壓力所造成之活化作用，三、尿路上皮細胞功能異常及增加尿路上皮之通透性，四、神經性發炎反應。基於這些可能的生成原因，對於間質性膀胱炎治療的原則，主要是根據：一、控制功能異常之尿路上皮細胞，補充膀胱表皮之GAG層，二、經由amitriptxline或imipramine以抑制神經性活化作用，三、利用抗組織胺抑制過敏反應，四、使用NSAID、Cox-2抑制劑或是鎮定劑作為疼痛控制。對於間質性膀胱炎使用膀胱內灌注肝素、hyaluronic acid、chondroitin sulphate、卡介苗、DMSO、仙人掌毒素，或是肉毒桿菌毒素A，都曾經被證明對於部分病人具有臨床的效果。但是這些藥物治療的安慰劑作用也應該被評估，而且在日後需要進行較進一步的隨機雙盲實驗，以瞭解真正的療效。由於間質性膀胱炎生成原因是多重因素，因此給予多種治療方法合併治療可能會有加成的作用，以及較好的治療結果。如果病人對於口服以及簡單的膀胱內藥物灌注治療無效，則可以考慮膀胱內注射肉毒桿菌毒素A，或是神經調節性治療，使得病人可以得到最後症狀改善的機會。

關鍵字

間質性膀胱炎 ； 膀胱內治療 ； 藥物治療

並列摘要

Interstitial cystitis (IC) is characterized by bladder pain associated with urgency, frequency, nocturia, dysuria and sterile urine. The diagnosis of this disease remains unclear and should be based on exclusion of other diseases. The possible etiologies of IC are (1) a post-infection autoimmune process, (2) mast cell activation induced by inflammation, toxins or stress, (3) urothelial dysfunction and increased permeability of the urothelium, or (4) neurogenic inflammation. The principles for treatment of IC are based on (1) controlling the dysfunctional epithelium by continual replenishment of the glycosaminoglycan (GAG) layer, (2) inhibiting neurological hyperactivity by administration of amitriptyline or imipramine, (3) suppression of allergies with antihistamines, and (4) pain control with non-steroid anti-inflammatory drugs (NSAID), Cox-2 inhibitors or tranquilizers. Intravesical treatment with heparin, hyaluronic acid, chondroitin sulphate, bacillus Calmette-Guerin (BCG), dimethylsulphoxide (DMSO), resiniferatoxin, or botulinum A toxin has been shown effective in some patients. However, the placebo effect should be weighed and randomized, double-blind trials should be undertaken to demonstrate the actual therapeutic effects of these therapeutic modalities. Since the etiology of IC is thought to be multi-factorial, multiple therapies might produce synergistic effects and a better outcome. For patients who are refractory to oral medication or intravesical instillation therapies, intravesical injections of botulinum A toxin or neuromodulation might provide symptomatic relief.

並列關鍵字

interstitial cystitis ； intravesical therapy ； medication