辣椒辣素类似物治疗膀胱过度活动症

Intravesical instillation of resiniferatoxin for the treatment of overactive bladder

目的 介绍辣椒辣素类似物RTX (Resiniferatoxin)治疗膀胱过度活动症的体会。 方法 膀胱过度活动症患者 30例 ,女 2 8例 ,男 2例。年龄 2 1～ 6 0岁 ,平均 39岁。病程 2～ 30年 ,平均 6 .9年。治疗前排尿日记显示日间排尿 9～ 2 6次 ,平均 15 .0次。夜间排尿 3～ 13次 ,平均 6 .4次。 12例经膀胱镜检查 ,10例显示黏膜呈慢性炎症改变。活检病理诊断腺性膀胱炎 1例 ,间质性膀胱炎 2例 ,其他为慢性炎症改变。膀胱灌注用 10 0nmol/LRTX溶液 10 0ml,膀胱内保留 30min。 结果 RTX灌注无膀胱刺激 ,不需用局部麻醉 ,未见明显副作用。灌注初始监测无逼尿肌收缩现象。 30例尿频症状于灌注后 1d开始改善 ,其中 2例伴尿痛者症状缓解 ;灌注 1周及 1个月后排尿日记显示日间排尿 5～15次 ,平均 8.9次 ,夜间排尿 0～ 5次 ,平均 3.0次 ;排尿频率明显减少 ,治疗前后相比 ,差异有显著性意义 (P <0 .0 0 1)。 结论 RTX膀胱灌注疗效好 ,无副作用 ,可作为膀胱过度活动症引起的下尿路症状的一种有效治疗手段。

Objective To evaluate the clinical outcomes of intravesical instillation of resiniferatoxin (RTX) for the treatment of overactive bladder(OAB). Methods 30 patients (28 females and 2 males) included in the study.The mean age was 39 years (range,21 to 60 years).The mean course of the illness was 6.9 years (range,2 to 30 years).The voiding diaries of pretreatment showed that frequency at day time varied from 9 to 26 times with a mean of 15.0 times;frequency at night ranged from 3 to 13 times with a mean of 6.4 times.Of the 12 patients undergoing cystoscopy 10 had chronic inflammation in both mucous and submucous.Based on biopsy 1 case was pathologically diagnosed as glandulous cystitis,2 as interstitial cystitis,and others as chronic inflammation.100 ml of RTX at a concentration of 100 nmol/L was intravesically instillated in all the patients and was retained within the bladder for 30 minutes. Results RTX instillation had no vesical irritation and other adverse effects,and no local anesthesia was required.The symptoms were improved immediately in all the patients after 1 day of RTX intervention.The decreases in both diurnal (5 to 15 times,mean 8.9 times) and nocturnal (0 to 5 times,mean 3.0 times) frequencies were significant(P<0.001)according to voiding diaries at 1 week and 1 month after treatment. Conclusions Intravesical instillation of RTX is efficacious treatment without side effects.It can be a promising therapeutic method for patients with overactive bladder.