透明质酸钠、肉毒素A治疗女性IC/PBS疗效观察

Curative effect of sodium hyaluronate and botulinum toxin A in female patients with IC/PBS

目的观察膀胱灌注透明质酸钠、膀胱内注射肉毒素A治疗女性间质性膀胱炎/膀胱疼痛综合征(IC/PBS)的疗效。方法 41例女性IC/PBS患者,其中行透明质酸钠膀胱灌注22例(A组),行肉毒素A膀胱内注射19例(B组)。评估患者治疗前及治疗后1、3、6个月临床症状(每日排尿次数、最大排尿量、疼痛程度评分)及O'Leary-Sant间质性膀胱炎问卷表评分情况,并记录不良反应发生情况。结果两组患者治疗后各时间点每日排尿次数、最大排尿量、疼痛程度评分、O'Leary-Sant评分与治疗前相比P均<0.05。治疗后6个月上述指标B组与A组相比P均<0.05,而治疗前及治疗后1个月两组比较P均>0.05。A组未出现严重不良反应。B组3例第3个月出现排尿困难,后逐渐改善,无其他不良反应。A、B组分别有2、1例在水扩张之后出现轻微肉眼血尿,后逐渐消失。A组有1例因心脏病中断治疗,其余患者均完成治疗及随访。结论膀胱内灌注透明质酸钠能有效缓解IC/PBS患者临床症状,改善其生活质量,患者耐受性及安全性较好。膀胱内注射肉毒素A短期内能缓解症状,但疗效随时间的推移进行性下降,且伴随少量不良反应的发生,不良反应随着药效的减退而逐渐改善。

Objective To observe the safety and efficacy of instillation of sodium hyaluronate therapy and intravesical botulinum toxin A（BTX-A） injections for the female patients with interstitial cystitis /painful bladder syndrome（IC /PBS）.Methods There were 41 IC /PBS patients in total.22 patients were given instillation of sodium hyaluronate therapy（group A）.Other 19 patients received BTX-A injections（group B）.Clinical symptoms（micturition frequency per day,maximal micturition volume and odynuria degree score）,O＇Leary-Sant symptom and problem index were assessed at baseline and then again after 1,3 and 6 months.Side effects were recorded.Compare two therapies,curative effect and side effects,and assess their safety and efficacy.Results Before therapy and after therapy,clinical symptoms,O＇Leary-Sant symptom and problem index of both groups patients,had significant differences（P0.05）.After 3 and 6 months,there were significant differences between two groups（P0.05）.Before therapy and after 1 month,clinical symptoms,O＇Leary-Sant symptom and problem index between two groups had no significant differences（P0.05）.Instillation of sodium hyaluronate therapy had no adverse effects.There were three patients who got dysuria in BTX-A injections group,no other side effects.Conclusions Instillation of sodium hyaluronate therapy can effectively relieve clinical symptom of IC/PBS and improve patients,quality of life and is well tolerated.It had a longer effect.Intravesical BTX-A injections had a short-term benefit,and it caused some side effects such as dysuria and voiding difficulty,which lasted several months until the effect of the treatment wore off.