摘要
间质性膀胱炎/膀胱疼痛综合征(IC/BPS)是一种以膀胱疼痛、尿急、尿频等症状为主的慢性疾病,严重影响患者的生活质量。尽管该病的发病机制仍不完全明了,但临床研究已揭示其涉及神经免疫学异常、膀胱上皮屏障功能破坏、慢性炎症反应及神经源性机制等多个复杂因素。当前的治疗方法虽有一定疗效,但普遍存在疗效有限、效果不持续等问题,尚缺乏针对病理机制的特异性治疗。文章阐述了IC/BPS的最新发病机制研究,重点关注慢性膀胱炎症、神经免疫反应及肥大细胞在病理过程中的作用。此外,作者对目前临床上常用的诊断手段进行了评估,包括病史采集、膀胱镜检查及尿动力学检查等,并讨论了膀胱镜检查中Hunner病变的识别及膀胱水扩张术的临床应用。在治疗方面,文章强调了现有治疗手段的局限性,并探讨了近年来新兴的治疗方法。除了传统的药物治疗和膀胱灌注疗法外,靶向治疗如富血小板血浆(PRP)注射、低能量体外冲击波治疗等在临床中的应用也逐步被重视,显示出较为积极的治疗前景。个体化治疗策略在未来的治疗中将成为重要方向,特别是针对疾病不同阶段和不同临床类型的患者。综上,IC/BPS作为一种病因复杂且多样的疾病,未来的治疗不仅需从缓解症状入手,而且更应注重对其病理机制的深入理解,探索更具特异性和长效的治疗策略,以提高患者的生活质量。
Interstitial cystitis/bladder pain syndrome(IC/BPS)is a chronic condition primarily characterized by bladder pain,urinary urgency,urinary frequency,and other symptoms,severely affecting patients'quality of life.Although the pathogenesis of this disease remains incompletely understood,clinical studies have revealed that it is associated with multiple complex factors,including neuroimmune abnormalities,disruption of the bladder epithelial barrier,chronic inflammatory responses,and neurogenic mechanisms.Current treatment methods have some efficacy but the effects are generally limited and unsustained,and there is a lack of specific treatments targeting the underlying pathological mechanisms.This review summarizes the latest researches on the pathogenesis of IC/BPS,with a focus on chronic bladder inflammation,neuroimmune responses,and the role of mast cells in the pathological process.Furthermore,the commonly used diagnostic approaches in clinical practice are evaluated,including medical history collection,cystoscopy,and urodynamic testing,and the identification of Hunner's lesions in cystoscopy and the clinical application of bladder hydro-distension are discussed.In terms of treatment,the review highlights the limitations of existing therapies and explores emerging treatment options.In addition to traditional pharmacological treatments and bladder instillation therapies,targeted treatments such as platelet-rich plasma(PRP)injections and low-energy extracorporeal shock wave therapy are gaining attention in clinical practice,showing promising therapeutic prospects.Personalized treatment strategies will become a crucial direction for future therapy,especially for the disease in different stages and the patients with different clinical types.In conclusion,IC/BPS is a disease with complex and diverse etiologies.Future treatments should not only focus on symptom relief but also emphasize a deeper understanding of its pathological mechanisms,and more specific and long-lasting therapeutic strategies should be explored to improve patients'quality of life.
作者
柯涵炜
许克新
KE Han-wei;XU Ke-xin(Department of Urology,Peking University People's Hospital,Beijing 100044,China)
出处
《中国实用妇科与产科杂志》
北大核心
2025年第5期517-524,共8页
Chinese Journal of Practical Gynecology and Obstetrics
基金
北京市自然科学基金(7242153)。
