临床表型分类法在间质性膀胱炎／膀胱疼痛综合征患者中的应用价值

Clinical phenotyping patients with interstitial cystitis/painful bladder syndrome： a key of classifica- tion and potentially improved management

目的探讨临床表型6个亚型（urinary，psychosocial，organ specific，infection，neurological／systemic and tenderness，UPOINT；泌尿、心理、器官特异性、感染、神经性和压痛）分类法在间质性膀胱炎／膀胱疼痛综合征（IC／PBS）患者中的应用价值。方法2009年11月至2011年10月收治IC／PBS患者54例。女42例，男12例。年龄21～76岁，平均（41．0±12．4）岁。病程6～240个月，平均（63．0±59．2）个月。采用UPOINT表型分类法对患者进行分类，同时采用间质性膀胱炎症状指数（interstitialcystitissymptomindex，ICSI）和盆腔疼痛、尿频尿急症状评分（pelvic pain and urgeney／frequency patient symptom scale，PUF）评估患者症状，视觉模拟评分法（visual analogue scale，VAS）分别评估与膀胱有关的疼痛、尿频、尿急症状。结果54例患者中，ICSI9～19分，平均（15．0±1．84）分。PUF评分14～25分，平均（20．0±2．3）分。与膀胱有关的疼痛VAS评分5～10分，平均（7．0±1．0）分；尿频评分8～10分，平均（9．0±0．9）分；尿急评分8—10分，平均（9．0±1．3）分。54例患者中，泌尿分类项目患者占100％，器官特异性分类项目占96％，社会心理分类项目占44％，感染分类项目占33％，神经性分类项目占24％，压痛分类项目占28％。占2项分类项目者11％，占3项分类项目者38％，占4项分类项目者36％，占5项分类项目者13％，占6项分类项目者2％。患者症状持续时间与所占项目数相关（r=0．76，P〈0．01）；ICSI与患者所占的分类项目阳性数相关（r=0．89，P〈0．01）；PUF评分与患者所占的分类项目数无相关性；患者所占分类项目的阳性数与VAS疼痛评分呈正比，与尿频、尿急VAS评分无相关性。结论UPOINT临床表型分类法可对IC／PBS患者临床症状进行划分，不仅可提高对IC／PBS患者的诊断率，还为制订IC／PBS患者的个体化治疗方案提供了理论基础。

Objective To classify patients with pelvic pain and to improve the understanding of etiology and to guide treatment by using a clinical phenotype system （UPOINT） and to examine the relationship between UPOINT and symptoms in patients with interstitial cystitis/painful bladder syndrome. Methods From November 2009 to October 2011, 54 IC/PBS patients including 42 female and 12 male patients were treated. The mean age was 41.0±12.4 yrs （range from 21 to 76 yrs）. Median symptom duration was 63.0 ± 59.2 months （ range from 6 to 240 months）. 54 patients with interstitial cystitis/painful bladder syndrome were classified in each domain of UPOINT, that was urinary, psychosocial, organ specific, infection, neurological/systemic and tenderness. Symptoms were assessed using the Interstitial Cystitis Symptom Index, Pain/Urgency/Frequency score and visual analogue scale for pain/urgency/frequency. Clinically relevant asociations were calculated. Results In the 54 IC/PBS patients, median ICSI score was 15.0 ± 1. 84 points （range from 9 to 19 points） ; Median PUF was 20.0 ±2.3 points （range from 14 to 25 points） ; Median pain associated with bladder score of VAS was 7.0 ± 1.0 points （range from 5 to 10 points）. The percent positive for each domain was urinary 100% , psychosoeial 44% , organ specific 96% , infection 33% , neurological/systemic 24% and tenderness 28% , respectively. All patients were included in at least 2 domains, with 2 domains of 11% , 3 domains of 38% , 4 domains of 36% , 5 domains of 13% and 6 domains of 2%. The number of domains was associated with greater symptom duration （ Spearman r = 0.76, P 〈 0.01 ） but not age. The number of domains was also associated with poorer general interstitial cystitis and pain symptoms （ Spearman r = 0.89, P 〈 0.01 ） but not with frequency or urgency. The psyehosocial domain was associated with increased pain, urgency and frequency, while tenderness was associated with increased ICSI score, PUF score and urgency. The neurological/systemic domain was associated with increased ICSI score while the infection domain was not associated with any increased symptoms. Conclusions The UPOINT phenotyping system can classify patients with interstitial cystitis according to clinically relevant domains. The UPOINT system can act as the guiding theoretical basis for directing multimodal therapy, it deserves clinical promotion.