Study On Diagnosis Treatment And Immunopathogenesis Ultramicropathogenesis Of Interstitial Cystitis

Objective1.To approach value of these items including pelvic pain and urgency /frequency patient symptom scale(PUF),potassium sensitivity test(PST)and urine K concentration in interstitial cystitis(IC)diagnosis.To evaluate effect of treatment using hydrodistention and irrigation of bladder for IC patients.2.To observe permeability and mast cell infiltrating condition of bladder mucosa in IC patients.To observe the expression of Th1 versus Th2 type cytokines in IC bladder mucosa.Materials and MethodsThe clinical data of 16 female IC patients(from 2006 March to 2007 December) were analyzed,the age was 51.25±10.19 years.16 controls were healthy subjects, the age was 53.13±9.63 years.The age of two groups were matched.1.PUF,PST and urine K concentration in IC group were determined at prior treatment,post-treatmental 3 months and 6 months.IC patients of final diagnosis were firstly treated by hydrodistention under continuous epidural anesthesia using a balloon.IC patients were treated by irrigation of bladder (heparin25000U+lidocaine10ml+NaHCO₃30ml)since preoperative 1 week,firstly one per week for 4 weeks;secondly twice per week for 8 weeks.Patients were followed up at 3 months and 6 months since post-treatment.2.Biopsy from two groups were observed through light microscope and transmission electron microscope.Immunohistochemistry was used to detect the expression of Th1/Th2 type cytokines in two groups' bladder mucosa using IFN-γand IL-2 as Th1 type cytokines,IL-4 and IL-10 as Th2 type cytokines.Results1.(1)There are significant difference between two groups about items including prior treatmental PUF,PST,urine K-to-Cr ratio and bladder maximum volume(respectively Z=4.782,Z=4.913,Z=4.372,Z=4,826).(2)There are significant positive correlation between PUF and PST before and after treatment(r_s =0.879,r_s =0.747,r_s=0.529).There are significant negative correlation between PUF and urine K-to-Cr ratio before and after treatment of 3 months(r_s=-0.656,r_s=-0.545).There are no significant correlation between PUF and urine K-to-Cr ratio after treatment of 6 months(r_s=-0.321).(3)There are significant difference among prior treatment, post-treatmental 3 months and 6 months about items including PUF,PST,urine K-to-Cr ratio and bladder maximum volume(F=78.726,F=89.401,F=8.508).Prior treatmental PUF was significantly higher than post-treatmental 3 months and 6 months,whereas PUF has no significant difference between post-treatmental 3 months and 6 months.Prior treatmental PST is significantly higher than post-treatmental 3 months and 6 months,whereas PST has no significant difference between post-treatmental 3 months and 6 months.Prior treatmental urine K-to-Cr ratio is significantly higher than post-treatmental 3 months and 6 months,whereas urine K-to-Cr ratio has no significant difference between post-treatmental 3 months and 6 months.Prior treatmental bladder maximum volume is significantly higher than post-treatmental 3 months and 6 months,whereas bladder maximum volume has no significant difference between post-treatmental 3 months and 6 months.2.(1)There are regions which appeare to be detached in IC patients' bladder mucosa through light microscope.There are many mast cells infiltrating in mucosa layer through light microscope in IC patients,there are significant difference between two groups(t=12.724,P＜0.05).(2)There are regions between cells in which portions of adjacent umbrella cells appeare to be detached in IC patients' bladder mucosa. Mast cells in IC group manifestate degranulation in electron microscope,there are significant difference between two groups(χ²=18.762,P＜0.05).(3)The expression of IFN-γand IL-2 in IC bladder mucosa has no significant difference with normal bladder mucosa(IFN-γ:χ²=1.900,IL-2:χ²=0.514).The expression of IL-4 and IL- 10 in IC bladder mucosa has significant difference with normal bladder mucosa(IL-4:χ²=8.237,IL-10:χ²=8.209).The expression of Th2 type cytokines has significant correlation with the degree of PUF,which intensifies in the IC of high PUEConclusion1.(1)Our study establishs diagnostic evaluational system of IC.PUF is a semiological index,PST and urine K concentration are indexs which can reflect permeability of bladder mucosa,Athrough urine K concentration will not bring pain to patients,it has lower specificity than PST.Therefore,we might utilize indexs combining PUF with PST for diagnosis of IC.(2)Hydrodistention using a balloon can significantly increase the patients' bladder volume.Irrigation of bladder using several kinds of medicine at the same time can reduce inflammation of bladder wall and repair mucosa of bladder.Treatment combined hydrodistention with irrigation of bladder can significantly improve symptom of IC patients.2.Our study elucidates initially originated mechanism of IC.Due to increased permeability of bladder mucosa,mass harmful material permeates submucosa and muscular layer.Accordingly,there lay a lot of inflammatory cells infiltrating (especially Th cells and mast cells).The expression pattern of Th2 type cytokines is predominant in IC bladder mucosa.Th2 type cytokines can activate mast cells,mast cells can release a lot of mediators of inflammation which can induce inflammatory reaction.Therefore,three important pathological changes of IC are increased permeability of bladder mucosa,Th1/Th2 drift of bladder mucosa,pack of mast cells infiltrating of bladder mucosa.