腺性膀胱炎的膀胱镜下表现

从１９７２年５月至１９９３年４月共收治腺性膀胱炎１４例。结合国内文献本文着重讨论腺性膀胱炎的膀胱镜下病变部位、分型、乳头状瘤型和膀胱乳头状肿瘤的鉴别和治疗等问题。     

彩色多普勒超声对腺性膀胱炎的鉴别诊断价值

目的 探讨彩色多普勒超声检查对腺性膀胱炎的鉴别诊断价值.方法 采用彩色多普勒超声检查39例腺性膀胱炎和192例膀胱癌患者,观察膀胱病变的位置、形态、边界、内部回声及其与膀胱壁的关系,并检查病变内部的血流分布,将其声像图表现进行对比分析.超声检查结果与膀胱镜活检或手术病理结果对照.结果 59.0%(23/39)腺性膀胱炎和52.9%(74/140)的单发膀胱癌病灶位于膀胱三角区及输尿管口周围;53.8%(21/39)的腺性膀胱炎表现为膀胱壁局限性增厚,72.9%(140/192)的膀胱癌为单发结节或团块,两者的病灶形态分布差异有统计学意义(P＜0.01);69.2%(27/39)的腺性膀胱炎病灶内部见囊状无回声区,而膀胱癌病变内均未见此声像改变;膀胱癌病灶边缘见点状强回声者占48.4%(93/192),而腺性膀胱炎仅为7.7%(3/39),二者差异有统计学意义(P＜0.01);彩色多普勒显示84.9%(163/192)膀胱癌病变内检出血流信号,其血流检出率明显高于腺性膀胱炎.彩色多普勒超声对腺性膀胱炎与膀胱癌的诊断准确率分别为84.6%(33/39)、95.3%(183/192).结论 彩色多普勒超声检查能清晰显示腺性膀胱炎的位置、边界、形态、内部回声及其与膀胱壁的关系,对腺性膀胱炎的鉴别诊断和临床随访有重要作用.     

造血干细胞移植后肾积水的病因及治疗

目的:探讨造血干细胞移植后肾积水的病因及治疗选择.方法:回顾性分析2004年3月至2014年3月接受造血干细胞移植(hematopoietic stem cell transplantation,HSCT)并在HSCT后出现肾积水的23例血液病患者资料,采集患者年龄、性别、是否出现出血性膀胱炎(hemorrhagic cystitis,HC)、HC发生距离HSCT的时间、HC程度、是否并发输尿管炎、是否并发病毒血症、肾积水治疗方法、治疗效果等资料,结合病历资料总结并分析发生肾积水的原因.将患者根据是否需要外科干预分为两组,再根据是否发生输尿管狭窄行输尿管扩张分为两组,均应用秩和检验、确切概率法检验评估两组间在HC发生距离HSCT的时间、是否并发输尿管炎、是否并发病毒血症等方面的差异是否有统计学意义.结果:出血性膀胱炎、输尿管炎、输尿管瘢痕狭窄均会造成HSCT后肾积水.HSCT后患者中69.6％ (16/23)经保守治疗后肾积水缓解,30.4％(7/23)经外科干预后缓解,其中13.0％(3/23)早期行膀胱镜留置内置输尿管支架管(DJ管)或肾造瘘术后缓解,17.4％ (4/23)后期出现输尿管瘢痕狭窄,经输尿管球囊扩张后2例患者成功拔除DJ管,1例患者需长期留置DJ管,1例患者仍在随访中.秩和检验及确切概率法检验结果显示:需要外科干预的HSCT后肾积水患者相对于保守治疗者发生HC的时间更晚、输尿管炎和病毒血症发病率更高,但两组间差异均无统计学意义(P值分别为0.524、0.169、0.124).发生输尿管瘢痕狭窄需输尿管扩张的HSCT后肾积水患者相对其他患者输尿管炎发病率更高,两组间差异有统计学意义(P =0.024);需输尿管扩张的患者相对于其他患者发生HC的时间更晚、病毒血症发病率更高,但两组间差异无统计学意义(P值分别为0.73、0.27).结论:HC、输尿管炎、输尿管瘢痕狭窄均会造成HSCT后患者肾积水,早期可先行保守治疗,对于HC出现晚、合并病毒血症、尤其是有输尿管炎的肾积水患者应密切随访,必要时可行膀胱镜DJ管置入或肾造瘘术等外科方式治疗,对于输尿管瘢痕狭窄的患者可行输尿管球囊扩张治疗.     

PGE2通过促进EP4受体表达调控脂多糖诱导的膀胱上皮细胞炎症反应

目的探讨PGE2对脂多糖诱导的膀胱上皮细胞炎症反应的影响及相关机制。 方法利用脂多糖诱导人正常膀胱上皮细胞（SV-HUC-1）建立膀胱炎细胞模型，采用实时荧光定量PCR检测PGE2作用后膀胱上皮细胞中EP4受体的表达水平变化。利用EP4受体激动剂和拮抗剂作用于膀胱上皮细胞，MTT方法检测其对细胞增殖的影响。最后分别利用PGE2及EP4受体激动剂、拮抗剂作用于膀胱上皮细胞，ELISA方法检测细胞培养液中IL-10、IL-6、IL-1β和TNF-α的变化。 结果PGE2促进膀胱上皮细胞中EP4受体的表达，并呈时间依赖。EP4受体激动剂（CAY10598）促进膀胱上皮细胞的细胞增殖，而EP4受体拮抗剂（AH23848）抑制细胞增殖（P<0.05）。ELISA法检测发现，PGE2和CAY10598能促进膀胱上皮细胞培养液中IL-10、IL-6、IL-1β和TNF-α等炎症因子的表达，而AH23848则起到抑制作用（P<0.05）。 结论PGE2通过上调EP4受体表达促进脂多糖诱导的膀胱上皮细胞炎症反应，PGE2/EP4受体有望是膀胱炎治疗的潜在靶点。     

Toll-like Receptor 4 and comorbid pain in Interstitial Cystitis/Bladder Pain Syndrome: A Multidisciplinary Approach to the Study of Chronic Pelvic Pain research network study

Background: Interstitial Cystitis/Bladder Pain Syndrome (IC/BPS) is a condition characterized by pelvic pain and urinary symptoms. Some IC/BPS patients have pain confined to the pelvic region, while others suffer widespread pain. Inflammatory processes have previously been linked to pelvic pain in IC/BPS, but their association with widespread pain in IC/BPS has not been characterized. Methods: Sixty-six women meeting criteria for IC/BPS completed self-report measures of pain as part of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP), collected 3 days of saliva for cortisol assays, and provided blood samples. Peripheral blood mononuclear cells (PBMCs) were stimulated with Toll-like Receptor (TLR) 2 and 4 agonists and cytokines were measured in supernatant; IL-6 was also measured in plasma. Associations between inflammatory variables and the likelihood of endorsing extra-pelvic pain, or the presence of a comorbid syndrome, were tested by logistic regression and General Linear Models, respectively. A subset of patients (n = 32) completed Quantitative Sensory Testing. Results: A one standard deviation increase in TLR-4 inflammatory response was associated with a 1.59 greater likelihood of endorsing extra-pelvic pain (p = .019). Participants with comorbid syndromes also had higher inflammatory responses to TLR-4 stimulation in PBMCs (p = .016). Lower pressure pain thresholds were marginally associated with higher TLR-4 inflammatory responses (p = .062), and significantly associated with higher IL-6 in plasma (p = .031). Conclusions: TLR-4 inflammatory responses in PBMCs are a marker of widespread pain in IC/BPS, and should be explored in other conditions characterized by medically unexplained pain.     

Phloroglucinol Protects the Urinary Bladder Via Inhibition of Oxidative Stress and Inflammation in a Rat Model of Cyclophosphamide-induced Interstitial Cystitis

Background:

Phloroglucinol plays an important role in oxidative stress and inflammatory responses. The effects of phloroglucinol have been proven in various disease models. The aim of the present study was to investigate the efficacy and possible mechanisms of phloroglucinol in the treatment of interstitial cystitis (IC).

Methods:

Thirty-two female Sprague-Dawley (SD) rats were used in this study. IC was induced by intraperitoneal injection of cyclophosphamide (CYP). Rats were randomly allocated to one of four groups (n = 8 per group): A control group, which was injected with saline (75 mg/kg; i.p.) instead of CYP on days 1, 4, and 7; a chronic IC group, which was injected with CYP (75 mg/kg; i.p.) on days 1, 4, and 7; a high-dose (30 mg/kg) phloroglucinol-treated group; and a low-dose (15 mg/kg) phloroglucinol-treated group. On day 8, the rats in each group underwent cystometrography (CMG), and the bladders were examined for evidence of oxidative stress and inflammation. Statistical analysis was performed by analysis of variance (ANOVA) followed by least square difference multiple comparison post-hoc test.

Results:

Histological evaluation showed that bladder inflammation in CYP-treated rats was suppressed by phloroglucinol. CMG revealed that the CYP treatment induced overactive bladder in rats that was reversed by phloroglucinol. Up-regulated tumor necrosis factor-α and interleukin-6 expression in the CYP-treated rats were also suppressed in the phloroglucinol treated rats. CYP treatment significantly increased myeloperoxidase activity as well as the decreased activities of catalase of the bladder, which was reversed by treatment with phloroglucinol.

Conclusions:

The application of phloroglucinol suppressed oxidative stress, inflammation, and overactivity in the bladder. This may provide a new treatment strategy for IC.     

腺性膀胱炎的诊断与治疗

目的：探讨腺性膀胱炎的临床特征与诊治效果。方法：通过对20例腺性膀胱患者行抗感染,经尿道汽化、电切、膀胱药物灌注等治疗方法。结果：本组20例获得随访,其中1例随访最长时间达到2年,1例6个月后复发,1例合并膀胱癌者9个月后膀胱癌复发,1例术后1年恶变,其余均治愈。结论：膀胱镜检查结合组织活检对诊断腺性膀胱炎具有重要意义,腺性膀胱炎具有恶变倾向,须定期随访复查。     

间质性膀胱炎病因学及治疗

目的探讨间质性膀胱炎（interstitial cystitis,IC）的诊断手段,以及病因学的多种模式,治疗的最新发展动向。方法对IC的30年来病因学、诊断学、治疗学、病理学、生理学发展资料汇总分析。结果IC其特点主要是膀胱壁的纤维化,并伴有膀胱容量的减少。以尿急、尿频、膀胱区胀痛为其主要症状。其发病机制到目前尚未完全清楚,主流医疗仍然认为免疫病变,感染因素、心理作用是IC的主要病因,间质性膀胱炎的诊断比较困难和复杂,易发生误诊,导致治疗无效。结论只有经过严谨的病因分析,诊断过程,良好的治疗方案,才可以极大的缓解并控制病情,但如果免疫治疗没有较大的突破性进展,IC的复发仍然是在很长时间内无法解决的问题,无法达到根治的目的。     

Xanthogranulomatous cystitis

Xanthogranulomatous cystitis (XC) is a rare benign chronic inflammatory disease of unknown etiology. We report a patient of XC managed with long-term antibiotics and augmentation cystoplasty. A 50-year-old man presented with urgency, frequency, hematuria and lower abdominal pain. Investigations revealed small capacity bladder with diverticula and cystoscopy showed inflamed bladder with multiple small polypoidal growth that had histological findings suggestive of XC on biopsy. Patient was treated with augmentation cystoplasty and prolonged administration of broad-spectrum antibiotics. Postoperative course was uneventful and patient remains asymptomatic at 1-year follow-up. XC is rare entity of unknown etiology. Patients may be given a trial of long-term broad-spectrum antibiotics.