Tamaki Masahiro, Saito Ryoichi, Ogawa Osamu, Yoshimura Naoki, Ueda Tomohiro
Department of Urology, Kouga Public Hospital, Shiga, 3-39 Rokushin, Minakuchi-cho, Kouga, Shiga 528-0014, Japan.
J Urol. 2004 Sep;172(3):945-8. doi: 10.1097/01.ju.0000135009.55905.cb.
Glomerulation has been one of the requisite criteria for the diagnosis of interstitial cystitis (IC) but the mechanisms for glomerulation remain unclear. Therefore, we investigated the relationship between the cystoscopic findings of vascular events and the expression of angiogenic growth factors in IC bladders to identify the possible mechanisms inducing glomerulations in IC.
In 45 patients suspected of having IC continuous, fixed point cystoscopic observation was performed during hydrodistention using spinal anesthesia. Bladder biopsies were performed in these cases and in an additional 5 asymptomatic cases. Thereafter, the expression of platelet derived endothelial cell growth factor/thymidine phosphorylase (PDECGF/TP) was measured by enzyme-linked immunosorbent assay. Immunohistochemical staining for PDECGF/TP and vascular endothelial growth factor was also performed.
Of 45 symptomatic patients 38 had glomerulations during cystoscopic examination. In these patients during hydrodistention the blood flow in bladder wall vessels was interrupted by whitish fibrous bundles. Thereafter petechial bleeding began from capillaries distal to obstructed vessels during bladder emptying. PDECGF/TP expression in patients with glomerulation was significantly higher than in symptomatic patients without glomerulation or asymptomatic patients (p < 0.001). In patients with glomerulations a high positive rate for PDECGF/TP (97.4%) and vascular endothelial growth factor (68.4%) staining was observed, while no positive staining was found in asymptomatic patients.
Glomerulations during hydrodistention are highly associated with the over expression of angiogenic growth factors in the bladder. Thus, it seems likely that neovascularization promoted by angiogenic growth factors has an important role in the pathogenesis of IC, inducing glomerulations during hydrodistension.
肾小球形成一直是间质性膀胱炎（IC）诊断的必要标准之一，但肾小球形成的机制仍不清楚。因此，我们研究了IC膀胱中血管事件的膀胱镜检查结果与血管生成生长因子表达之间的关系，以确定IC中诱导肾小球形成的可能机制。
对45例疑似IC患者，在脊髓麻醉下膀胱水扩张时进行连续、定点膀胱镜观察。对这些病例以及另外5例无症状病例进行膀胱活检。此后，通过酶联免疫吸附测定法测量血小板衍生内皮细胞生长因子/胸苷磷酸化酶（PDECGF/TP）的表达。还进行了PDECGF/TP和血管内皮生长因子的免疫组织化学染色。
45例有症状患者中，38例在膀胱镜检查时有肾小球形成。在这些患者膀胱水扩张期间，膀胱壁血管中的血流被白色纤维束中断。此后，在膀胱排空时，阻塞血管远端的毛细血管开始出现瘀点出血。有肾小球形成的患者中PDECGF/TP表达明显高于无肾小球形成的有症状患者或无症状患者（p<0.001）。在有肾小球形成的患者中，观察到PDECGF/TP染色的高阳性率（97.4%）和血管内皮生长因子染色的高阳性率（68.4%），而无症状患者未发现阳性染色。
膀胱水扩张期间的肾小球形成与膀胱中血管生成生长因子的过度表达高度相关。因此，血管生成生长因子促进的新生血管形成似乎在IC的发病机制中起重要作用，在膀胱水扩张期间诱导肾小球形成。
