潰瘍型及非潰瘍型間質性膀胱炎病人在臨床表現以及膀胱組織免疫學組織染色的差異
張嘉峰、郭漢崇
慈濟醫院泌尿科
Clinical characteristics and immunochemical study of urothelial dysfunction in the patients with interstitial cystitis/bladder pain syndrome with and without hunner’s lesion
Jia-Fong Jhang, Hann-Chorng Kuo
Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
Purpose: Current consensus suggests the patients with interstitial cystitis(IC)/bladder pain syndrome (BPS) could be subdivided into two types, ulcerative and non-ulcerative, according to cystoscopic finding. The clinical characteristics in the patients with ulcerative and non-ulcerative IC/BPS are different, but the pathophysiology and underlying mechanism difference between these patients were still unclear. The objective of this study is to investigate the urothelium difference and clinical characteristics in the patients with ulcerative and non-ulcerative IC/BPS
Materials and Methods: Ten female patients with ulcer IC/BPS and 22 patients with non-ulcer IC/BPS who were admitted for cystoscopic hydrodistention were prospectively enrolled into this study. Bladder mucosa biopsy was taken during the procedure. Immunofluorescence staining and quantification of the adhesion protein E-cadherin, tight junction protein zona occuldens-1 (ZO-1), sensory protein M2, M3, P2X3 were carried out. Tryptase levels, eNOS and a TUNEL assay were used to assess mast-cell activation, inflammation and urothelial apoptosis, respectively. Ten healthy control bladder biopsies were also taken for staining
Results: The patients with ulcer IC/BPS is significantly older than the patients with non-ulcer IC/BPS (57.38±7.76 vs. 46.59±13.88, p=0.013). The VAS is significant higher in the ulcer IC/BPS, while the cystometric bladder capacity and urgency snesation in urodynamic study are smaller. Both ulcer and non-ulcer IC/PBS patients had lower E-cadherine, ZO-1 and M3 in bladder tissue than healthy control. Both ulcer and non-ulcer IC/BPS groups also had higher typtase and TUNEL than control group. The bladder tissue of ulcer IC/BPS have significantly lower E-cadherin and higher TUNEL than that non-ulcer IC/BPS bladder tissue (12.71±9.77 vs 25.00±13.30, p=0.011; 3.83±3.21vs 1.80±1.82, p=0.05, respectively). The eNOS expression in ulcer type IC/BPS is also higher than that in non ulcer IC/BPS (0.46±0.32 vs 0.07±0.08, p<0.001).
Conclusions: Our data suggested the patients of ulcer IC/BPS had more severe clinical symptoms. The bladder tissues of IC/BPS patients had defective adhesion protein, increased suburothelial inflammation, urothelial cell apoptosis and M3 receptor. The defective bladder barrier function, urothelial cell apoptosis and eNOS induced inflammation are more severe in the patients with ulcer IC/BPS than that in the patients with non-ulcer IC/BPS.