透明质酸联合肝素灌注治疗难治性间质性膀胱炎

Intravesical hyaluronic acid combined with heparin in the treatment of refractory interstitial cystitis

目的探讨透明质酸联合肝素灌注治疗难治性间质性膀胱炎的疗效。方法对24例难治性女性间质性膀胱炎患者采用透明质酸40 mg、肝素4万U混合膀胱灌注,膀胱内保留60 min。每周1次,连续8周,之后改为每月1次,连续4月,随访6个月。观察治疗前后患者每日排尿次数、平均每次尿量、O’Leary-Sant间质性膀胱炎问卷评分(ICSI/ICPI)、盆腔疼痛评分(PUF)变化及钾离子试验和膀胱镜检。结果 23例患者完成治疗和随访,随访3月时,每日排尿次数明显减少、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<0.01)。随访6月时,各项指标维持,与随访3月相比,差异无统计学意义(P>0.05),与治疗前相比,差异有统计学意义(P<0.01)。钾离子试验阳性患者由治疗前的16例降为2例。19例患者黏膜下出血点消失或减轻。结论透明质酸联合肝素灌注治疗难治性间质性膀胱炎疗效确切。

Objective To evaluate the efficacy of intravesical instillation of hyaluronic acid（HA） and heparin for refractory interstitial cystitis（IC）.Methods A total of 24 patients with IC were enrolled.They received intravesical 40 mg HA and 40 000 U heparin weekly for 8 weeks and then monthly for 4 months.Patients were followed up for 6 months after the last instillation.The voids per day,average urine volume,O＇Leary-Sant interstitial cystitis symptom index and problem index（ICSI/ICPI）,and pelvic pain and urgency frequency（PUF） were observed before and after treatment,and cystoscopy and potassium sensitivity test was performed before and after treatment.Results A total of 23 patients completed the treatment and the follow-up.At 3 month after follow-up,voids per day decreased significantly,average urine volume increased significantly,and ICSI,ICPI,PUF also decreased significantly（P0.01）.At 6 month after follow-up,all indices were sustained and were better than those before treatment（P0.01）,but there was no significant difference between month 6 and month 3（P0.05）.The patients with positive potassium sensitivity test decreased from 16 to 2,and the bleeding point of mucous membrane disappeared or was alleviated in 19 patients.Conclusion The efficacy of intravesical instillation of HA and heparin is reliable for patients with refractory IC.