Logadottir Y R, Ehren Ingrid, Fall Magnus, Wiklund N Peter, Peeker Ralph, Hanno Philip M
Department of Urology, Sahlgrenska University Hospital, Götenborg, Sweden.
J Urol. 2004 Mar;171(3):1148-50; discussion 50-1. doi: 10.1097/01.ju.0000110501.96416.40.
Interstitial cystitis (IC) is one of the most bothersome conditions in urological practice. There are 2 subtypes, classic and nonulcer IC, with similar symptoms but different outcomes with respect to clinical course and response to treatment. Histologically there are fundamental differences between the 2 subtypes, classic IC presenting a severe abnormality of the urothelium and characteristic inflammatory cell infiltrates while inflammation is scant in nonulcer IC. Regulation of urinary nitric oxide synthase activity has been proposed to be of importance for immunological responses in IC. We present evidence of a profound difference between the 2 subtypes concerning nitric oxide production, mirroring the differences in inflammatory response in IC.
A total of 17 patients with both subtypes and active disease as well as patients with disease in remission were included in the study, all diagnosed according to National Institute for Diabetes and Digestive and Kidney Diseases criteria. Luminal nitric oxide was measured in the bladder of patients using a chemiluminescence nitric oxide analyzer.
All patients with classic IC had high levels of NO. None of the other patients had any significant increase in NO levels in the bladder. The NO level in patients with classic IC was not related to symptoms but rather to the assignment to this specific subgroup of IC. The highest levels of NO were found in patients in the initial phase of classic IC.
The difference in NO evaporation between classic and nonulcer IC allows for subtyping of cases meeting National Institute for Diabetes and Digestive and Kidney Diseases criteria without performing cystoscopy. The findings in the present series together with previous findings clearly demonstrate that the 2 subtypes of IC represent separate entities. This separation further emphasizes the need to subtype all cases included in all scientific matters, ensuring that the 2 subtypes are evaluated separately in clinical studies.
间质性膀胱炎（IC）是泌尿外科临床中最棘手的病症之一。它有两种亚型，即经典型和非溃疡型IC，二者症状相似，但在临床病程和对治疗的反应方面预后不同。从组织学上看，这两种亚型存在根本差异，经典型IC表现为尿路上皮严重异常和特征性炎性细胞浸润，而非溃疡型IC炎症则很轻微。有人提出，尿一氧化氮合酶活性的调节对IC的免疫反应很重要。我们提供的证据表明，这两种亚型在一氧化氮生成方面存在显著差异，这反映了IC炎症反应的差异。
本研究共纳入17例两种亚型的活动性疾病患者以及病情缓解的患者，所有患者均根据美国国立糖尿病、消化和肾脏疾病研究所的标准进行诊断。使用化学发光一氧化氮分析仪测量患者膀胱内的管腔一氧化氮。
所有经典型IC患者的一氧化氮水平都很高。其他患者膀胱内的一氧化氮水平均无显著升高。经典型IC患者的一氧化氮水平与症状无关，而是与该特定IC亚组的分类有关。经典型IC初始阶段的患者一氧化氮水平最高。
经典型和非溃疡型IC在一氧化氮蒸发方面的差异使得在不进行膀胱镜检查的情况下，符合美国国立糖尿病、消化和肾脏疾病研究所标准的病例能够进行亚型分类。本系列研究结果与先前的研究结果清楚地表明，IC的这两种亚型代表不同的实体。这种区分进一步强调了在所有科学研究中对所有病例进行亚型分类的必要性，以确保在临床研究中对这两种亚型分别进行评估。
