阿米替林联合透明质酸钠、肝素治疗间质性膀胱炎的临床疗效评价

Efficacy and safety of amitriptyline combined with sodium hyaluronat and heparin for interstitial cystitis

目的探讨口服阿米替林联合膀胱灌注透明质酸钠、肝素治疗间质性膀胱炎/膀胱疼痛综合征(interstitial cystitis/painfulbladder syndrome,IC/PBS)的临床疗效和安全性。方法 24例IC/PBS患者行口服阿米替林联合膀胱灌注透明质酸钠、肝素治疗。麻醉下膀胱镜检查及水扩张后,诊断明确所有患者即开始口服阿米替林25mg/d,最大剂量75mg/d;同采用透明质酸40mg、肝素25 000U混合液膀胱灌注、每周1次,4次后改每月1次。观察治疗前及治疗后3、6个月的排尿次数、排尿量和Oleary saint问卷表评分(OLeary-Sant patient symptom/problem index scores,ICSI/ICPI);盆腔疼痛及尿频评分(pelvic painand urgency frequency questionnaire,PUF);第6月复查膀胱镜。结果 22例患者完成本研究,随访3、6月时,每日排尿次数明显减少,尤其是夜尿次数,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<0.001);治疗6月与治疗3月相比差异除夜尿次数及PUF评分外,其他各项指标均无统计学意义(P>0.05)。6月复查膀胱镜检查,19例黏膜下出血点消失或减轻,3例膀胱三角区炎性改变。结论阿米替林联合透明质酸钠、肝素治疗IC/PBS安全有效。

Objective To investigate the efficacy and safety of amitriptyline combined with sodium hyaluronat and heparin for interstitial cystitis（IC）.Methods A total of 24 patients with IC were enrolled.All patients took 25~75 mg amitriptyline per day for 1 week and received bladder irrigation of 40 mg sodium hyaluronat and 25 000 U heparin weekly for 4 weeks,and then monthly for 7~9 months.The urination frequency,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 treatment and 3 and 6 months after treatment.Results 3 and 6 months after the treatment,the urination frequency reduced significantly,and the average urine volume increased obviously.The ICSI,ICPI and PUF decreased significantly（P0.001）.Except for the night urination frequency and PUF,there was no significant difference among the indexes obtained 3 and 6 months after the treatment（P0.05）.When the patients were reexamined 6 months after treatment,19 of 22 showed the bleeding points of mucous membrane disappeared or alleviated.Conclusion Oral amitriptyline combined with intravesical instillation of sodium hyaluronat and heparin is safe,reliable and effective for the treatment of interstitial cystitis.