反复膀胱内注射肉毒素A联合膀胱水扩张治疗间质性膀胱炎/盆腔疼痛综合征的远期疗效评估

Evaluation of the Long-term Effect of Repeated Intravesical Injection of Botulinum Toxin A in the Treatment of IC/PBS

目的探讨反复膀胱内注射肉毒素A(botulinum toxin A,BoNT-A)治疗间质性膀胱炎/盆腔疼痛综合征(interstitial cystitis/bladder pain syndrome,IC/PBS)的疗效及安全性,比较不同注射次数的有效率。方法选取2006年6月至2020年6月赤峰医学院附属医院收治的42例IC/PBS患者,均接受第1次膀胱内注射BoNT-A 200 U。按接受治疗次数将患者分为4组,分别为仅接受1次治疗组(1组,对照组)、接受2次治疗组(2组)、接受3次治疗组(3组)和接受4次治疗组(4组),每次治疗间隔6个月。术后3个月评估间质性膀胱炎症状指数(interstitial cystitis symptom index,ICSI)、间质性膀胱炎问题指数(interstitial cystitis problem index,ICPI)、疼痛视觉模拟评分(visual analog scale,VAS)、排尿日记参数及尿动力学参数。用多因素分析和Kaplan-Meier分析比较各组的有效率。结果1组42例,2组31例,3组22例,4组16例。ICSI、ICPI及VAS均提示2、3、4组疗效优于1组,差异有统计学意义(P<0.05)。随访25年,多次膀胱内注射BoNT-A较单次注射疗效持续时间更长。结论反复膀胱内注射BoNT-A是IC/PBS安全有效的治疗方法,其可以有效缓解疼痛,增加膀胱容量,较单次膀胱内注射疗效持续时间更长。

Objective To evaluate the efficacy and safety of intravesical injection of botulinum toxin A(BoNT-A)in the treatment of interstitial cystitis(IC/PBS),and to compare the effectiveness of different injection times.Methods All 42 patients received the first intravesical injection of BoNT-A200 U.The patients were divided into 4 groups according to the number of treatments received,namely the group receiving only 1 treatment(group 1),the group receiving 2 treatments(group 2),the group receiving 3 treatments(group 3),and the group receiving 4 treatments(4 groups).Group1 as the control group.To evaluate the interstitial cystitis symptom index(ICSI),interstitial cystitis problem index(ICPI),pain visual analog scale(VAS),urination diary parameters and urodynamic parameters.Multivariate analysis and Kaplan-Meier analysis were used to compare the effectiveness of each group.Results The group 1 of 42 people,the group 2 of 31 people,the group 3 of 22 people,the group 4 of 16 people.ICSI,ICPI,and VAS all indicate that with the increase in the number of intravesical injections of BoNT-A,the curative effect increases significantly(P<0.05).And ICPI did not increase significantly.Follow-up 2-5 years found that multiple intravesical injections of BoNT-A lasted longer than a single injection.Conclusion Repeated intravesical injection of BoNT-A is a safe and effective treatment method for IC/PBS.It can effectively relieve pain,increase bladder capacity,and last longer than a single intravesical injection.