Theoharides Theoharis C, Whitmore Kristine, Stanford Edward, Moldwin Robert, O'Leary Michael P
Tufts University School of Medicine, Department of Pharmacology and Experimental Therapeutics, Experimental Therapeutics 136 Harrison Avenue, Boston, MA 02111, USA.
Expert Opin Pharmacother. 2008 Dec;9(17):2979-94. doi: 10.1517/14656560802519845.
Interstitial cystitis is characterized by over 6 months of chronic pain, pressure and discomfort felt in the lower pelvis or bladder. It is often relieved with voiding, along with daytime frequency and nocturia in the absence of a urinary tract infection. Interstitial cystitis occurs primarily in females including adolescents and its diagnosis is still one of exclusion. It is now recognized as a serious medical condition associated with significant disability.
The aim of this paper was to review the pathogenesis and treatment of interstitial cystitis with emphasis on new pathogenetic trends and therapeutic modalities.
About 713 mostly original papers were reviewed in Medline from 1990 to August. 2008. All authors independently reviewed the literature. Large, double-blind, placebo-controlled, clinical trials were few and the medical histories of the patients used varied considerably making conclusions difficult. Promising pilot trials turned out mostly negative on follow-up.
Increasing evidence of co-morbid diseases, neurogenic inflammation and the effect of stress are promising as new targets for pathophysiology. No new effective treatments have emerged. Oral pentosanpolysulfate, amitriptyline, hydroxyzine and quercetin, as well as intravesical heparin/bicarbonate/lidocaine solutions, are still used with variable success. Some pilot open-label trials presented encouraging findings.
Interstitial cystitis contributes substantially to chronic pelvic pain and to poor quality of life. Oral or intravesical administration of solutions containing sodium hyaluronate, chondroitin sulfate and quercetin to both reduce bladder inflammation and 'replenish' the glycosaminoglycan layer should be tried. There is a clear need for therapeutic modalities. New potential translational research areas are suggested.
间质性膀胱炎的特征是下腹部或膀胱出现持续超过6个月的慢性疼痛、压迫感和不适感。排尿时常可缓解症状，同时伴有白天尿频和夜尿，且无尿路感染。间质性膀胱炎主要发生于包括青少年在内的女性，其诊断仍然是排除性诊断之一。目前它被认为是一种与严重残疾相关的严重疾病。
本文旨在综述间质性膀胱炎的发病机制和治疗方法，重点关注新的发病趋势和治疗方式。
检索了1990年至2008年8月Medline数据库中的约713篇主要为原创性的论文。所有作者独立查阅文献。大型、双盲、安慰剂对照的临床试验较少，且所使用患者的病史差异很大，难以得出结论。有前景的试点试验在随访中大多结果为阴性。
越来越多的证据表明合并症、神经源性炎症和应激的影响有望成为病理生理学的新靶点。尚未出现新的有效治疗方法。口服聚多卡醇硫酸酯、阿米替林、羟嗪和槲皮素，以及膀胱内注射肝素/碳酸氢盐/利多卡因溶液，仍在使用，但效果不一。一些开放性试点试验呈现出令人鼓舞的结果。
间质性膀胱炎是导致慢性盆腔疼痛和生活质量低下的重要原因。应尝试口服或膀胱内给予含透明质酸钠、硫酸软骨素和槲皮素的溶液，以减轻膀胱炎症并“补充”糖胺聚糖层。显然需要新的治疗方式。文中提出了新的潜在转化研究领域。
