Warren John W, Jian Ningbo, Gallicchio Lisa, Wu David, Clauw Daniel J
Department of Medicine, University of Maryland School of Medicine, Baltimore, MD; Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD.
Urology. 2018 Aug;118:52-58. doi: 10.1016/j.urology.2018.05.004. Epub 2018 Jun 27.
To test the hypothesis that risk factors for bladder pain syndrome/interstitial cystitis (BPS/IC) in women differ between those with and without the BPS/IC prodrome.
Incident cases of BPS/IC and healthy controls were recruited nationally. More than half the BPS/IC cases reported subsyndromal urinary symptoms for decades before onset of BPS/IC and were identified as having the prodrome. Risk factors for BPS/IC were examined separately for cases with and without the prodrome using a set of matched controls.
Two risk factors distinguished 178 prodrome from 134 non-prodrome cases. One was "UTIs" in the year before BPS/IC onset, possibly a manifestation of the prodrome itself. The other was the presence of the maximal number of nonbladder syndromes (NBSs): prodrome cases were 12 times more likely than non-prodrome cases to have ≥4 NBSs. Additional risk factors for prodrome and/or non-prodrome cases were the direct association of exogenous female hormones, as well as 3 inverse associations: type 2 diabetes mellitus, multiple pregnancies, and current daily smoking.
Prodrome cases developed urinary symptoms in their early 20s (ie, the prodrome) and were at very high risk of numerous NBSs. Non-prodrome cases developed urinary symptoms in their early 40s (ie, full-blown BPS/IC) and were no more likely than controls to have the maximal number of NBSs. These findings are consistent with recent suggestions of two BPS/IC phenotypes: one with systemic and psychosocial manifestations and the other more specific to the bladder. Additionally, several risk factors identified here might be hints of related or causal nervous system pathophysiologies.
检验以下假设，即患有膀胱疼痛综合征/间质性膀胱炎（BPS/IC）前驱症状的女性与未患该前驱症状的女性相比，BPS/IC的危险因素存在差异。
在全国范围内招募BPS/IC的新发病例和健康对照。超过一半的BPS/IC病例在BPS/IC发病前数十年就报告有亚综合征性泌尿系统症状，并被确定为患有前驱症状。使用一组匹配的对照，分别对有和无前驱症状的病例进行BPS/IC危险因素的检查。
两个危险因素区分了178例有前驱症状的病例和134例无前驱症状的病例。一个是在BPS/IC发病前一年出现“尿路感染”，这可能是前驱症状本身的一种表现。另一个是存在最大数量的非膀胱综合征（NBSs）：有前驱症状的病例出现≥4种NBSs的可能性是无前驱症状病例的12倍。前驱症状和/或无前驱症状病例的其他危险因素包括外源性女性激素的直接关联，以及3种反向关联：2型糖尿病、多次妊娠和当前每日吸烟。
有前驱症状的病例在20岁出头时（即前驱症状期）出现泌尿系统症状，并且有很高的风险出现多种NBSs。无前驱症状的病例在40岁出头时（即典型的BPS/IC）出现泌尿系统症状，并且出现最大数量NBSs的可能性并不比对照组高。这些发现与最近关于BPS/IC两种表型的观点一致：一种具有全身和心理社会表现，另一种更局限于膀胱。此外，这里确定的几个危险因素可能暗示了相关或因果性的神经系统病理生理学。
