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逼尿肌联合三角区注射A型肉毒素+水扩张治疗间质性膀胱炎/膀胱疼痛综合征的临床疗效

The clinical effectiveness of detrusor combined triangle injection of Botulinum toxin type A plus hydrodistention in treating interstitial cystitis/bladder pain syndrome

摘要:

目的 探讨A型肉毒素联合水扩张治疗间质性膀胱炎/膀胱疼痛综合征(interstitial cystitis/bladder pain syndrome,IC/BPC)的疗效和安全性及不同注射部位对治疗效果的影响.方法 2011年10月至2016年2月确诊为IC/BPC的患者69例,男5例,女64例.年龄23 ~ 66岁,平均44.5岁.将69例按照随机数字表法分为3组:对照组(A组)、治疗组B组和治疗组C组.A组行水扩张,B组行逼尿肌联合三角区A型肉毒素注射+水扩张,C组行单独三角区A型肉毒素注射+水扩张.A组23例,男1例,女22例;年龄23 ~ 69岁,平均44.6岁;病程6~ 23个月,平均12.5个月;体重指数18 ~ 25 kg/m2,平均22.4 kg/m2.B组24例,男2例,女22例;年龄27 ~ 65岁,平均42.8岁;病程6 ~19个月,平均12.7个月;体重指数19 ~ 25 kg/m2,平均22.6 kg/m2.C组22例,男2例,女20例;年龄30~68岁,平均44.3岁;病程6~21个月,平均12.9个月;体重指数19 ~ 25 kg/m2,平均22.5 kg/m2.3组治疗前的基线资料差异均无统计学意义(均P>0.05).比较3组治疗前及治疗后1、3、6、9个月的白天排尿次数、夜尿次数、疼痛视觉模拟评分(visual analogue scale/score,VAS》)、功能性膀胱容量(functional cystemetric volume,FCV)、残余尿量(post-void residual volume,PVR)、最大尿流率(Qmax)、最大膀胱容量(maximal bladder capacity,MBC)、间质性膀胱炎症状指数(interstitialcystitis symptom index,ICSI)、间质性膀胱炎问题指数(interstitial cystitis problem index,ICPI)、生活质量评分(QOL)及汉密顿焦虑量表(Hamilton anxiety scale,HAMA)评分变化情况.结果 治疗后3组均未出现严重并发症.治疗后1个月各项指标均较治疗前明显改善.治疗后3个月时A组效果明显下降,与术前比较仅白天排尿次数(7.0与14.0)、夜尿次数(3.0与5.0)和Qmax(14.0 ml/s与13.0 ml/s)有显著改善(均P<0.05),其余指标与术前比较差异均无统计学意义;但B、C组改善仍较明显,B、C组白天排尿次数、夜尿次数、VAS、ICSI、ICPI、HAMA评分仍较术前显著下降(均P <0.05),FCV、MBC、Qmax、QOL仍较术前显著提高(均P<0.05),除Qmax和夜尿次数外,B组其余指标与同一时间A组相比,差异有统计学意义(均P <0.05),C组除Qmax、夜尿次数及躯体焦虑评分外,其余指标与同一时间A组相比,差异均有统计学意义(均P <0.05);B组与C组比较,VAS(2.0与3.0)、躯体焦虑症状评分(6.0与10.0)均优于C组(均P<0.05).治疗后6个月A组尿频、尿急及疼痛症状恢复至术前,各指标与术前比较差异无显著性意义(均P>0.05);但治疗组白天排尿次数、夜尿次数、VAS、ICSI、ICPI、HAMA评分仍较术前显著下降(均P<0.05),FCV、MBC、Qmax、QOL仍较术前显著提高(均P<0.05),B组除PVR、Qmax、QOL外,其余指标与同一时间A组相比,差异均有统计学意义(均P <0.05),C组除PVR、Qmax、MBC、ICSI、QOL外,其余指标与同一时间A组相比,差异均有统计学意义(均P <0.05);B组与C组比较,ICPI(6.0与8.0)、躯体焦虑症状评分(7.0与10.0)优于C组,差异均有统计学意义(均P<0.05).治疗后9个月时A、B、C组效果均明显下降,与治疗前比较差异均无统计学意义;但B组ICSI(10.0与13.0)、ICPI(9.0与13.0)、QOL(5.0与6.0)和C组QOL(5.0与6.0)较A组改善,差异均具有统计学意义(均P<0.05);B组与C组的ICSI(10.0与12.0)和MBC(285.0 ml与237.5 ml)比较差异均有统计学意义(均P<0.05).结论 逼尿肌内A型肉毒素注射联合水扩张可有效缓解IC/BPC患者的症状,改善患者的生活质量,降低焦虑评分,是一种安全有效的治疗方法,同时逼尿肌联合三角区注射的效果优于单独三角区注射.

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abstracts:

Objective To evaluate the effectiveness and security of Botulinum toxin type A (BTX-A) in treating interstitial cystitis /bladder pain syndrome,and also the effect of different site injection.Methods Sixty-nine consecutive BPS/IC patients from October 2011 to February 2016 were divided into three groups randomly,including control group (group A) and treatment group (group B and group C).There were 5 males and 64 females,with age from 23 to 66 years old (average 44.5 years old).Twentythree patients (1 male and 22 females,aged from 23 to 69 years old,with mean age of 44.6 years old) in control group (group A) underwent hydrodistention.Twenty-four patients (2 males and 22 females,aged from 27 to 65 years old,with mean age of 42.8 years old) in group B underwent BTX-A detrusor combined triangle injection plus hydrodistention.Twenty-two patients (2 males and 20 females,aged from 30 to 68 years old,with mean age of 44.3 years old) in group C underwent BTX-A triangle injection alone plus hydrodistention.The parameters such as daytime frequency,nocturia,visual analogue scale/score (VAS),functional cystemetric volume (FCV),post-void residual volume (PVR),QOL score,maximal bladder capacity (MBC),interstitial cystitis symtom index (ICSI),interstitial cystitisproblem index (ICPI),Qmax,and Hamilton anxiey scale (HAMA) score between pre-treatment and 1,3,6 and 9 months after therapy in the three groups were compared.Results There were no serious complications observed in the three groups.All parameters 1 month after therapy were obviously superior to that of pretreatment.The efficacy in control group decreased significantly 3 months after treatment except nocturia (3.0 vs.5.0),daytime frequency(7.0 vs.14.0)and Q (14.0 ml/s vs.13.0 ml/s).However,all parameters in research groups except PVR were still obviously superior to pretherapy.The parameters except Q and nocturia in group B had statistically significant difference from contemporaneous group A (all P < 0.05).However,the parameters except Q nocturia and somatic anxiety score in group C had statistically significant difference from contemporaneous group A (all P < 0.05).VAS (2.0 vs.3.0) and somatic anxiety score (6.0 vs.10.0) in group B were superior to group C (all P < 0.05).When it came to 6 months after therapy,urinary frequence and urgency and pain symptoms were the same to pretherapy and all parameters had no statistically significant difference between pretherapy and after therapy in group A(all P > 0.05).But all parameters except PVR in research group was still superior to pretherapy.the parameters except PVR,Q and QOL in group B had statistically significant difference from contemporaneous group A (all P < 0.05).However,The parameters except PVR,Q MBC,ICSI and QOL in group C had statistically significant difference from contemporaneous group A (all P < 0.05).Meanwhile,efficacy in group B was better than group C in term of ICPI (6.0 vs.8.0) and somatic anxiety score (7.0 vs.10.0) (all P < 0.05).The efficacy decreased significantly 9 months after treatment in both group B and C,with no statistically significant difference compared with that of pretreatment.ICSI(10.0 vs.13.0),ICPI(9.0 vs.13.0),QOL(5.0 vs.6.0)in group B,and QOL(5.0 vs.6.0)in group C had statistically significant difference compared with the contemporary parameters in group A.ICSI(10.0 vs.12.0),MBC(285.0 ml vs.237.5 ml) in group B was better than that in group C (P < 0.05).Conclusions Symptoms in IC/BPS patients can be alleviated significantly by detrusor BTX-A injection plus hydrodistention.Quality of life can be improved remarkably and HAMA scores can be reduced significantly after treatment.Thus,it's an effective therapeutic mnethod for IC/BPS,and detrusor combined triangle injection can provide a better effect than single triangle injection.

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