Erickson Deborah R, Tomaszewski John E, Kunselman Allen R, Stetter Christina M, Peters Kenneth M, Rovner Eric S, Demers Laurence M, Wheeler Marcia A, Keay Susan K
Department of Surgery, Division of Urology, University of Kentucky College of Medicine, Lexington, Kentucky 40536-0298, USA.
J Urol. 2008 May;179(5):1850-6. doi: 10.1016/j.juro.2008.01.047. Epub 2008 Mar 18.
We tested for associations between urine markers, bladder biopsy features and bladder ulcers in interstitial cystitis/painful bladder syndrome.
Subjects were 72 patients with interstitial cystitis/painful bladder syndrome undergoing bladder distention and biopsy. Urine was collected before the procedure. Urine marker levels were correlated with biopsy and cystoscopic findings. Patients with no previous interstitial cystitis/painful bladder syndrome treatments (47) were analyzed separately from previously treated patients (25).
For untreated patients urine interleukin-6 and cyclic guanosine monophosphate were associated with urothelial epidermal growth factor receptor staining (for interleukin-6 r = 0.29; 95% CI 0.07, 0.51; p = 0.01 and for cyclic guanosine monophosphate r = 0.34; 95% CI 0.13, 0.55; p = 0.002). Urine interleukin-8 was negatively associated with urothelial heparin-binding epidermal growth factor-like growth factor staining (r = -0.34; 95% CI -0.55, -0.12; p = 0.002) and positively associated with lamina propria mast cell count (r = 0.29; 95% CI 0.06, 0.52; p = 0.01). The latter association also was seen in treated patients (r = 0.46; 95% CI 0.20, 0.73; p <0.001). None of the urine markers was significantly different for ulcer vs nonulcer groups. All of the patients with ulcer had extensive inflammation on bladder biopsy including severe mononuclear cell infiltration, moderate or strong interleukin-6 staining in the urothelium and lamina propria, and leukocyte common antigen staining in more than 10% of the lamina propria. However, these features also were seen in 24% to 76% of the patients without ulcer.
Overall urine markers did not associate robustly with biopsy findings. The strongest association was a positive association between urine interleukin-8 levels and bladder mast cell count. Patients with ulcer consistently had bladder inflammation but the cystoscopic finding of ulcers was not a sensitive indicator of inflammation on bladder biopsy.
我们检测了间质性膀胱炎/疼痛性膀胱综合征患者尿液标志物、膀胱活检特征与膀胱溃疡之间的相关性。
研究对象为72例接受膀胱扩张及活检的间质性膀胱炎/疼痛性膀胱综合征患者。在操作前收集尿液。将尿液标志物水平与活检及膀胱镜检查结果进行关联分析。将未曾接受过间质性膀胱炎/疼痛性膀胱综合征治疗的患者（47例）与既往接受过治疗的患者（25例）分开分析。
对于未治疗的患者，尿液白细胞介素-6和环磷酸鸟苷与尿路上皮表皮生长因子受体染色相关（白细胞介素-6的r = 0.29；95%可信区间0.07, 0.51；p = 0.01，环磷酸鸟苷的r = 0.34；95%可信区间0.13, 0.55；p = 0.002）。尿液白细胞介素-8与尿路上皮肝素结合表皮生长因子样生长因子染色呈负相关（r = -0.34；95%可信区间-0.55, -0.12；p = 0.002），与固有层肥大细胞计数呈正相关（r = 0.29；95%可信区间0.06, 0.52；p = 0.01）。在接受过治疗的患者中也观察到了后者的相关性（r = 0.46；95%可信区间0.20, 0.73；p <0.001）。溃疡组与非溃疡组的尿液标志物均无显著差异。所有溃疡患者膀胱活检均有广泛炎症，包括严重的单核细胞浸润、尿路上皮和固有层中度或强阳性的白细胞介素-6染色，以及超过10%的固有层白细胞共同抗原染色。然而，在无溃疡的患者中也有24%至76%出现了这些特征。
总体而言，尿液标志物与活检结果的相关性不强。最强的关联是尿液白细胞介素-8水平与膀胱肥大细胞计数之间的正相关。溃疡患者始终存在膀胱炎症，但膀胱镜检查发现的溃疡并非膀胱活检炎症的敏感指标。
