阿米替林治疗间质性膀胱炎的临床研究

目的 探讨阿米替林治疗间质性膀胱炎的有效性和安全性. 方法 采用前瞻性研究.间质性膀胱炎患者54例,病程19～72个月,平均(40.7±11.6)个月.口服阿米替林治疗,起始剂量25 mg/次,每晚1次.1周后,若症状不缓解,可加量至50 mg/次;再观察1周,若症状仍不缓解,则可加量至75 mg/次;维持能够缓解症状的最小剂量,总疗程3个月.观察用药前及用药3个月后患者的临床症状(每日排尿次数、最大排尿容量、尿痛程度评分)和O'Leary-Sant间质性膀胱炎问卷表评分及生活质量评分情况.并记录不良反应发生情况. 结果 ①用药3个月后每日排尿次数明显减少,治疗前后分别为(28.5±8.4)和(15.6±3.3)次;最大排尿容量明显增加,治疗前后分别为(108.7±62.2)和(171.0±53.9)ml;尿痛程度评分明显下降,治疗前后分别为6.4±1.5和2.2±1.5,上述指标用药前后相比,差异均有统计学意义(P<0.01).②患者用药3个月后问卷评分和生活质量评分均明显减少,治疗前后分别为26.9±4.0和13.7±5.7及5.5±0.5和2.5±0.6;用药前后比较,差异有统计学意义(P<0.01).③45例在服药第1个月内有不同程度的困倦,43例1个月后自行缓解,2例由于困倦严重且不能缓解而停药.10例服药3个月后体质量增加(5.8±1.8)kg.11例有轻度便秘症状,可以耐受.9例有口干症状,可以耐受.3例出现重度排尿困难,停药后改为其他方法治疗. 结论 阿米替林口服治疗能有效缓解间质性膀胱炎患者的临床症状,改善生活质量,且耐受性及安全性好.     

阿米替林联合透明质酸钠、肝素治疗间质性膀胱炎的临床疗效评价

目的探讨口服阿米替林联合膀胱灌注透明质酸钠、肝素治疗间质性膀胱炎/膀胱疼痛综合征（interstitial cystitis/painfulbladder syndrome,IC/PBS）的临床疗效和安全性。方法 24例IC/PBS患者行口服阿米替林联合膀胱灌注透明质酸钠、肝素治疗。麻醉下膀胱镜检查及水扩张后,诊断明确所有患者即开始口服阿米替林25mg/d,最大剂量75mg/d;同采用透明质酸40mg、肝素25 000U混合液膀胱灌注、每周1次,4次后改每月1次。观察治疗前及治疗后3、6个月的排尿次数、排尿量和Oleary saint问卷表评分（OLeary-Sant patient symptom/problem index scores,ICSI/ICPI）;盆腔疼痛及尿频评分（pelvic painand urgency frequency questionnaire,PUF）;第6月复查膀胱镜。结果 22例患者完成本研究,随访3、6月时,每日排尿次数明显减少,尤其是夜尿次数,平均每次尿量明显增加,ICSI、ICPI、PUF评分明显降低,差异有统计学意义（P〈0.001）;治疗6月与治疗3月相比差异除夜尿次数及PUF评分外,其他各项指标均无统计学意义（P〉0.05）。6月复查膀胱镜检查,19例黏膜下出血点消失或减轻,3例膀胱三角区炎性改变。结论阿米替林联合透明质酸钠、肝素治疗IC/PBS安全有效。     

阿米替林联合透明质酸钠治疗膀胱疼痛综合征/间质性膀胱炎的临床研究(附58例报告)

目的:探讨联合应用阿米替林和透明质酸钠治疗膀胱疼痛综合征/间质性膀胱炎(BPS/IC)的临床疗效和安全性。方法:对58例BPS/IC患者行膀胱灌注透明质酸钠和口服阿米替林治疗。所有患者在膀胱镜检+水扩张后,病理诊断为非特异性炎症者并且统计肥大细胞数目,然后膀胱灌注透明质酸钠。第1个月每周1次,连续灌注4周,然后每月1次,直到第6个月。观察用药前及用药1、3、6个月时的临床症状情况(每日排尿次数、最大排尿容量、膀胱区疼痛程度评分)和O’Leary-Sant间质性膀胱炎问卷表评分及生活质量评分(QOL)情况。在第一次灌注透明质酸钠的同时持续口服阿米替林25mg/每晚,1周后根据患者耐受情况增加阿米替林至每日口服25mg两次,6个月。实验期间均观察患者有无不良反应。到了治疗后第6个月所有入组患者复查膀胱尿道镜检时再次膀胱黏膜随机活检,观察膀胱黏膜炎症的变化,病理上再次统计肥大细胞数目,与治疗前的肥大细胞数目相比较有无统计学的差异。结果:58例总有效率62.1%(36/58),其中完全缓解率为39.7%(23/58),部分缓解率为22.4%(13/58),治疗无效率为37.9%(22/58)。治疗前所有患者平均每日排尿次数、每次排尿量、疼痛程度、O’Leary Sant评分、生活质量评分和膀胱黏膜下肥大细胞计数与治疗后相比均存在显著改善(均P值<0.001)。结论:阿米替林联合透明质酸钠治疗BPS/IC能有效缓解患者的临床症状和改善其生活质量。     

膀胱扩张术联合药物治疗间质性膀胱炎患者的护理

对19例间质性膀胱炎患者行膀胱扩张术和口服阿米替林和/或二甲基亚砜膀胱灌注治疗。结果 19例患者均完成治疗,17例症状明显缓解,20例改用辣椒辣素类似物(RTX)膀胱灌注后症状缓解。患者平均尿量显著增加,24 h排尿次数、夜尿次数显著减少,VAS评分显著降低,总尿量则无明显改变。提出术前做好症状量化评估和解释工作,术后严密观察导尿管引流,做好用药护理、预防感染、心理支持及健康教育,出院做好心理疏导,妥善安排膀胱灌注及随访时间是良好效果的保证。     

膀胱扩张术联合药物治疗间质性膀胱炎患者的护理

对19例间质性膀胱炎患者行膀胱扩张术和口服阿米替林和/或二甲基亚砜膀胱灌注治疗。结果 19例患者均完成治疗,17例症状明显缓解,20例改用辣椒辣素类似物（RTX）膀胱灌注后症状缓解。患者平均尿量显著增加,24 h排尿次数、夜尿次数显著减少,VAS评分显著降低,总尿量则无明显改变。提出术前做好症状量化评估和解释工作,术后严密观察导尿管引流,做好用药护理、预防感染、心理支持及健康教育,出院做好心理疏导,妥善安排膀胱灌注及随访时间是良好效果的保证。     

躯体功能及总体健康感在女性间质性膀胱炎治疗过程中的变化

目的探讨间质性膀胱炎（IC）治疗前后躯体功能（PF）及总体健康感（GH）的变化。方法2005年5月-2009年5年,依据症状及膀胱镜检查诊断间质性膀胱炎31例,其中23例符合美国国立糖尿病、消化病和。肾病研究所（NIDDK）的诊断标准。所有患者开始均口服阿米替林25mg,1次／d。治疗一周效果不佳者加服阿米替林至50mg／d,最大不超过100mg／d。对效果不佳或不能耐受阿米替林副作用的患者加用500g／L二甲基亚砜50mL膀胱灌注连续10次（其中4例用500g／L二甲基亚砜50mL＋10000u低分子肝素钠灌注）,总疗程3个月。观察指标：O’Leary间质性膀胱炎症状指数及问题指数、PF及GH。结果31例患者均完成治疗,25例患者取得良好的效果,6例患者效果较差。结论随着女性IC患者病情好转其躯体功能得到改善,患者的总体健康满意度提高。     

间质性膀胱炎

间质性膀胱炎(IC)是临床上一种较少见的疾病,其发病率无确切统计,以尿频、排尿困难,下腹部及尿道的疼痛为主要临床表现,女性多见。一、病因及病原学其病因不甚清楚,最近几年越来越多的研究表明本病系一自身免疫性疾病,因在某些IC病人身上用免疫学方法可查到抗膀胱粘膜的抗体,而在细菌性膀胱炎中并没有发现。Mattila于1983年在20例IC中发现70％病人出现见于自身免疫性疾病的典型血管内皮改变。Parviar也指出,IC与其它自身免疫性疾病有某些共同特点,如多发于女性(90％),常伴有SLE,类风湿性关节炎,结节性多动脉炎,硬皮病及自身免疫性甲状腺炎等。     

口服药物治疗间质性膀胱炎

口服药物治疗间质性膀胱炎王晋，王仁顺，莫克俭间质性膀胱炎（ＩＣ）是多因素引起的疾病，其确切病因和发病机理尚不清楚，与自身免疫、膀胱粘膜氨基葡聚糖（ＧＡＧ）缺陷、交感神经反射性营养不良（ｒｅｆｌｅｘｓｙｍｐａｔｈｅｔｉｃｄｙｓｔｒｏｐｈｙ，ＲＳＤ）、膀...     

间质性膀胱炎的研究进展

间质性膀胱炎对于泌尿外科、妇产科医生仍是一大未攻克的难题。目前的诊断仍以排除性诊断为主。腰麻下进行膀胱镜检查仍是临床诊断的重要组成部分之一。还未有一种单一的药物治疗能够应用到所有病患人群。选择最少毒性作用的序贯治疗可能是最好的治疗手段,而联合药物治疗可能也有临床价值。     

Intravesical bacillus Calmette-Guerin and dimethyl sulfoxide for treatment of classic and nonulcer interstitial cystitis: a prospective, randomized double-blind study

PURPOSE: We conducted a prospective, double-blind study with a crossover design of intravesical bacillus Calmette-Guerin (BCG) and dimethyl sulfoxide to determine whether patients with classic and nonulcer interstitial cystitis, respectively, might benefit from either regimen. MATERIALS AND METHODS: A total of 21 patients, including 11 with classic and 10 with nonulcer interstitial cystitis, randomly underwent treatments with intravesical BCG or dimethyl sulfoxide and, if not improved, were treated with the other substance after a washout period. All 21 patients were evaluated with symptom questionnaires, including a visual analog pain scale and voiding diaries. RESULTS: Regardless of regimen, there was no improvement in maximal functional capacity. There was a reduction in urinary frequency following dimethyl sulfoxide treatment but only in the classic subtype (p <0.05), whereas no reduction was seen following BCG in either subtype. A substantial pain decrease was noted in classic (p <0.05) as well as nonulcer (p <0.05) interstitial cystitis following dimethyl sulfoxide. CONCLUSIONS: Intravesical BCG has been presented as a promising new option for treatment of interstitial cystitis. We failed to demonstrate benefit from this treatment. Dimethyl sulfoxide had no positive effect on maximal functional capacity but resulted in a significant reduction in pain and urinary frequency, although only in patients with classic interstitial cystitis.     

A prospective, randomized, placebo controlled, double-blind study of amitriptyline for the treatment of interstitial cystitis

PURPOSE: We conducted a prospective study to examine the safety and efficacy of the tricyclic antidepressant amitriptyline in patients with interstitial cystitis (IC). MATERIALS AND METHODS: The study comprised 44 women and 6 men who all met the symptom criteria of the National Institute of Diabetes, Digestive and Kidney Diseases for IC. The patients were randomly assigned to amitriptyline or placebo. Patients were prospectively treated for 4 months with a self-titration protocol that allowed them to escalate drug dosage in 25 mg increments in 1 week-intervals (maximum dosage 100 mg). The change from baseline in the O'Leary-Sant IC symptom and problem index was the primary outcome parameter. Changes in functional bladder capacity and frequency (48-hour voiding log), and intensity of pain and urgency (visual analog scales) were chosen as secondary outcome parameters. RESULTS: Two patients (1 on amitriptyline, 1 on placebo) dropped out of the study due to side effects. Thus, the data of 48 patients (24 patients in each group) were available for evaluation. Mean symptom score decreased from 26.9 to 18.5 in the amitriptyline group compared with 27.6 to 24.1 in the placebo group (p = 0.005). Pain and urgency intensity improved statistically significantly in the amitriptyline group compared with the placebo group (p <0.001). The frequency and functional bladder capacity improved to a much greater degree in the amitriptyline group but the differences were not statistically significant (p = 0.063, p = 0.083). Anticholinergic side effects were reported by all except 2 patients in the amitriptyline group (92%) and by 5 patients in the placebo group (21%). Mouth dryness was the most frequent side effect reported in the amitriptyline group (79%). CONCLUSIONS: Amitriptyline therapy for 4 months is safe and effective for treating IC. A statistically significant change in the symptom score and statistically significant improvement of pain and urgency intensity compared with placebo were observed. Anticholinergic side effects constitute the major drawback of amitriptyline treatment for IC.     

Long-term results of amitriptyline treatment for interstitial cystitis

Purpose:

We performed a prospective, open label study to examine the safety and efficacy of the long-term administration of the tricyclic antidepressant amitriptyline in patients with interstitial cystitis (IC).

Materials and Methods:

A total of 94 patients were stratified into 2 groups, namely a National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) group of those who fulfilled NIDDK criteria for IC and a nonNIDDK group of those who presented with characteristic IC symptoms but met at least 1 NIDDK exclusion criterion. Amitriptyline was received strictly at bedtime following an established self-titration protocol without a limitation of the maximum daily dose. Patients reporting improvement in a global response assessment questionnaire were considered treatment responders. Further efficacy measures were changes in pain and urgency, functional bladder capacity and frequency. Changes in the O′Leary-Sant IC index and rating of overall satisfaction with the therapeutic outcome were also reported.

Results:

Mean study followup ± SD was 19.0 ± 12.5 months. The response rate was 64% (60 patients). The overall mean dose was 55 mg (range 12.5 to 150). Side effects occurred in 79 patients (84%), including dry mouth in 79% and weight gain in 59%. Patient overall satisfaction with the therapeutic result was excellent or good in 43 (46%). The dropout rate was 31% (29 patients) after a mean treatment period of 6 weeks at a mean dose of 70 mg. Nonresponse to treatment was the primary reason for dropout in all cases, while side effects contributed to dropout in 25 (86%). Improvement in the various IC symptoms was statistically significant compared with baseline.

Conclusions:

Long-term administration of amitriptyline is a feasible, safe and effective treatment for IC, provided that the drug is used judiciously to minimize adverse effects. The therapeutic response to amitriptyline was uniformly observed in patients fulfilling NIDDK criteria and in those with the pure clinical diagnosis of IC.     

多药联合治疗间质性膀胱炎的临床分析

目的:探讨多种药物联合治疗间质性膀胱炎(IC)的有效性和安全性。方法:24例女性IC患者,平均年龄(43.4±8.9)岁,随机分为A、B两组,每组12例。A组口服阿米替林、托特罗定;B组除口服A组药物外加用碱化利多卡因联合肝素膀胱灌注治疗,将2%利多卡因15ml+肝素50 000U+5%碳酸氢钠10ml+0.9%氯化钠10ml混合液行膀胱灌注,保留30min,每周两次。观察并对比A、B两组治疗前及治疗后3个月和6个月每日排尿次数、最大排尿量、疼痛评分,O’Leary-Sant IC评分和生活质量评分(QOL)情况。并记录不良反应发生情况。结果:①治疗3个月和6个月后,A、B两组各项指标明显改善,分别与治疗前相比差异均有统计学意义(P<0.05);而且,治疗后相同时间段A、B两组各项指标之间差异也均有统计学意义(P<0.05)。治疗后不同时间段,A组各项指标之间差异无统计学意义(P>0.05),而B组各项指标之间差异均有统计学意义(P<0.05)。②A、B两组患者全部接受完治疗,A组中共有3例出现倦怠、2例出现口干,均可耐受;B组中2例出现倦怠,2例灌注后出现轻度肉眼血尿,均自行缓解。结论:阿米替林、托特罗定同时使用是治疗IC合适的口服药物方案,而服药同时早期就进行利多卡因加肝素膀胱灌注的联合治疗方案,不仅能够显著提高IC治疗的短期效果,也可以增加远期疗效,而且耐受性和安全性较好,是值得临床推广的方案。     

Intravesical liposome therapy for interstitial cystitis

Over the past two decades, there has been lot of interest in the use of liposomes as lipid‐based biocompatible carriers for drugs administered by the intravesical route. The lipidic bilayer structure of liposomes facilitates their adherence to the apical membrane surface of luminal cells in the bladder, and their vesicular shape allows them to co‐opt the endocytosis machinery for bladder uptake after instillation. Liposomes have been shown to enhance the penetration of both water‐soluble and insoluble drugs, toxins, and oligonucleotides across the bladder epithelium. Empty liposomes composed entirely of the endogenous phospholipid, sphingomyelin, could counter mucosal inflammation and promote wound healing in patients suffering from interstitial cystitis. Recent clinical studies have tested multilamellar liposomes composed entirely of sphingomyelin as a novel intravesical therapy for interstitial cystitis. In addition, liposomes have been used as a delivery platform for the instillation of botulinum toxin in overactive bladder patients. The present review discusses the properties of liposomes that are important for their intrinsic therapeutic effect, summarizes the recently completed clinical studies with intravesical liposomes and covers the latest developments in this field.