膀胱内灌注纤维蛋白溶解抑制剂对卡介苗与膀胱壁结合力的影响

Influence upon Bacillus Calmette-Guerin attachment to bladder wall by intravesical instillation of antifibrinolytic agents

目的 通过研究膀胱内灌注纤维蛋白溶解抑制剂对卡介苗 (BCG)与膀胱壁结合力的影响 ,探讨提高BCG抗肿瘤疗效的新方法。方法 将30只家兔在膀胱内分别行切割伤、电灼伤、冷冻伤后随机分成5组。A组膀胱内单纯灌注PBS液 ,B组灌注PBS液 +同位素标记后的BCG(3H -BCG) ,C组灌注氨基已酸 (EACA) +3H -BCG ,D组灌注氨甲苯酸 (PAMBA) +3H -BCG ,E组灌注肝素 +3H -BCG。随后切取各损伤处及未损伤处膀胱壁 ,测定其 3H -BCG的结合量。 结果 BCG在膀胱壁3种损伤处的结合量均远高于未损伤处 (均P<0.01) ;C、D组BCG的结合量均明显高于B组 (均P<0.01) ;而E组BCG结合量则明显低于B组 (P<0.01)。 结论 膀胱内灌注纤维蛋白溶解抑制剂可增强BCG与膀胱壁的结合力 ,而纤溶促进剂肝素则作用相反 ,提示前者可提高BCG的抗肿瘤疗效。

Objective To evaluate the influence upon Bacillus Calmette-Guerin (BCG) attachment to bladder wall by intravesical instillation of antifibrinolytic agents and provide a new approach of BCG instillation. Methods Thirty rabbits were equally divided into five groups and the bladder mucosa of every rabbit was injured by electrocautery,cryocautery and incision respectively. Then different drugs were instilled into bladders.Group A: pure PBS instillation;Group B:PBS and radiolabeled BCG (3H-BCG);Group C :EACA and 3H _ BCG;Group D:PAMBA and 3H-BCG;Group E:heparin and 3H-BCG. After instillation,the injured bladder wall and non-injured wall were surgically removed and the quantities of BCG adherence were determined.Results The quantity of BCG attachment to injured bladder wall was significantly higher than that of non-injured wall (P<0.01).The mean level of Group C or Group D was significantly higher than that of Group B (P<0.01) while the mean level of Group E was significantly lower than that of Group B (P<0.01). Conclusions Intravesical instillation of antifibrinolytic agent EACA or PAMBA can enhance BCG attachment to bladder wall while fibrinolytic agent heparin inhibit it. This means the former may enhance BCG antineoplastic effect.