窄带成像膀胱镜诊断间质性膀胱炎的应用

Application of narrow-band imaging cystoscopy in the diagnosis of interstitial cystitis

目的评估窄带成像(narrow-band imaging,NBI)膀胱镜在诊断间质性膀胱炎(interstitial cystitis,IC)中的应用价值。方法 2009年9月至2014年3月,将来海军总医院就诊的65例被高度怀疑为IC的患者纳入研究。首先由1名高年资泌尿外科医师行腰椎麻醉下传统白光(WLI)模式镜检;接着由另1名低年资泌尿外科医师独立行NBI模式镜检。随后,由以上2名医师共同在行水扩张试验后WLI模式下镜检,并对患者膀胱黏膜异常区域进行活检。结果 65例患者中,水扩张试验前行WLI镜检,5例可见溃疡性病变,23例可见非溃疡性毛细血管丰富区;水扩张试验前行NBI镜检,28例WLI镜检阳性者均被检出,另有31例WLI镜检阴性者被发现存在非溃疡性毛细血管丰富区。水扩张试验后行WLI镜检,5例溃疡性病变者可见溃疡处黏膜破裂出血,所有NBI镜检非溃疡性毛细血管丰富区阳性者(54例)及2例NBI镜检阴性者可观察到多处点状出血和肾小球样红斑。61例膀胱黏膜异常者行活检,59例为慢性炎症,2例为原位癌。由此确诊IC共59例。水扩张试验前,WLI镜检诊断IC的敏感度、特异度和Kappa指数分别为44.1%、66.7%、0.032;而NBI镜检诊断IC的敏感度、特异度和Kappa指数分别为96.6%、66.7%、0.633。结论与WLI膀胱镜比较,NBI膀胱镜在水扩张试验前诊断IC敏感度更高,其镜检阳性区域同水扩张试验后阳性区域高度一致,对IC的诊断有较高应用价值。

Objective To investigate the value of narrow-band imaging（ NBI） cystoscopy in the diagnosis of interstitial cystitis（ IC）. Methods From Sep. 2009 to Mar. 2014,65 patients highly suspected of having IC were included in the study. First,conventional white-light imaging（ WLI） cystoscopy was performed under spinal anesthesia by a senior urologist. Then,NBI cystoscopy was conducted independently by a junior urologist. Following hydro-distention test,the above two urologists made conventional observation by WLI cystoscopy,and biopsy was performed to see if abnormal bladder mucosa could be detected. Results Conventional WLI cystoscopy before hydrodistention revealed that 5 patients out of 65 had ulcerative pathological lesion and 23 patients had non-ulcerative capillary-rich area. When NBI cystoscopy was administered,28 WLI-positive cases were detected,and another 31 WLI-negative cases were found to have non-ulcerative capillary-rich area. WLI cystoscopy after hydrodistention revealed that 5 cases with ulcerative lesion had mucosa rupture with bleeding at the site of ulcer,and all the 54 cases with non-ulcerative capillary-rich area under NBI cystoscopy and 2 NBI-negative cases were found to have petechial hemorrhage and glomerulus-like erythema. Biopsies performed in 61 cases with abnormal bladder mucosa revealed that 59 cases had chronic inflammation and 2 cases were diagnosed to be carcinoma in situ. Thus,59 were confirmed to be IC cases. In the diagnosis of IC under the WLI mode before hydrodistention,the sensitivity,specificity and Kappa values were 44. 1%,66. 7% and 0. 032 respectively,while under NBI mode,the sensitivity,specificity and Kappa values were96. 6%,66. 7% and 0. 633 respectively. Conclusion Compared with WLI cystoscopy,NBI cystoscopy seemed to be more sensitive in the diagnosis of IC before hydrodistention. The NBI-positive area was highly identical to the positive area after hydrodistention. It had good application value in IC diagnosis.