【 文献重点摘要 】

Intravesical onabotulinumtoxinA (BoNT-A) injections have been proposed to treat both overactive bladder (OAB) and interstitial cystitis/bladder pain syndrome (IC/BPS) in patients with refractory conditions. We compared adverse events (AEs) after BoNT-A treatment between IC/BPS and OAB in women. IC/BPS patients who failed conventional treatments were enrolled to receive suburothelial injections of BoNT-A (100 U) followed by hydrodistention. Age matched OAB female patients refractory to antimuscarinic agents underwent BoNT-A (100 U) injections. The bladder capacity , maximum flow rate (Qmax), post-void residual (PVR), and voiding efficiency (VE) at baseline, 3 and 6 months, and the post-treatment AEs were analyzed between groups. Finally, 89 IC/BPS and 72 OAB women were included. In the OAB group, the bladder capacity and PVR increased, and VE decreased significantly at three and six months after BoNT-A treatment. In the IC/BPS group, the Qmax increased significantly at six months. There were significant differences in changes of capacity , Qmax, PVR and VE between the two groups. Moreover, OAB patients suffered more frequently from events of hematuria, UTI, and large PVR (>200 mL), but less frequently from events of straining to void. In conclusion, OAB women had higher PVR volume and lower VE than those in IC/BPS after BoNT-A injections. These results imply that the bladder contractility of OAB patients are more susceptible to BoNT-A, which might reflect the different mechanisms of action of Botox on bladder dysfunction. Further investigations to confirm this hypothesis are warranted.

Keywords

onabotulinumtoxinA; adverse events; interstitial cystitis; overactive bladder

膀胱内注射丝裂霉素A(BONT-A)可同时治疗顽固性膀胱过度活动症(OAB)和间质性膀胱炎/膀胱痛综合征(IC/BPS)。我们比较了IC/BPS和OAB在女性中接受BONT-A治疗后的不良事件(AEs)。常规治疗失败的IC/BPS患者接受上皮下注射BONT-A(100U)，然后进行水力膨胀。年龄匹配的OAB女性患者对抗血吸虫药物无效，接受了BONT-A(100U)注射。比较两组基线、3个月、6个月的膀胱容量、最大尿流率(Qmax)、排尿后残留率(PVR)、排尿效率(VE)及治疗后AEs。最终纳入89名IC/BPS和72名OAB妇女。OAB组治疗后3个月和6个月膀胱容量和PVR显著增加，VE显著降低。在IC/BPS组，Qmax在6个月时显著增加。两组容量、Qmax、PVR、VE变化有显著性差异。此外，OAB患者更常出现血尿、尿路感染和大PVR(>200mL)事件，但较少出现劳损到排尿的事件。综上所述，OAB组注射BONT-A后PVR容量高于IC/BPS组，VE低于IC/BPS组。这些结果提示OAB患者的膀胱收缩功能对BONT-A更敏感，这可能反映了肉毒杆菌毒素对膀胱功能障碍的不同作用机制。进一步的调查以证实这一假设是有必要的。

关键词

肉毒毒素A；不良事件；间质性膀胱炎；膀胱过度活动症