The Criteria For Diagnose And Treatment Of Interstitial Cystitis And Related Fundamental Research

Objective:1.To approach value of PUF,PST,24 hour urine K-to-Cr ratio in diagnose ofinterstitial cystitis(IC),and to evaluate the effect of hydrodistention,irrigation fortreating IC patients.2.To approach value of APF activity in diagnose of IC,isolocate and purify APFfrom IC urine.3.To approach value of bladder mucosal mast cell in diagnose and pathogenesyof IC;to observe the expression of Th1 versus Th2 type cytokines in IC blood plasmand bladder tissues.Materials and Methods:The clinical data of 16 female IC patients were analyzed.Normal controls are 16matched healthy subjects without bladder diseases.1.PUF,PST and 24 hour urine K-to-Cr ratio in IC group were determined atprior treatment,post-treatment of 3 months and 6 months.IC patients of finaldiagnosis were first treated by hydrodistention under continuous epidural anesthesiausing a balloon.Patients in IC group were treated by irrigation of bladder andfollowed up at 3 months and 6 months since post-treatment.2.MTT was used to detect APF activity of IC.APF were isolocated and purifiedfrom IC urine with HPLC methods.3.Biopsy from two groups were observed through light microscope andtransmission electron microscope.ELISA and immunohistochemistry were used todetect the expression of Th1/I'h2 type cytokines in two groups blood plasm andbladder tissues using IFN-γand IL-2 as Th1 type cytokines,IL-4 and IL-10 as Th2type cytokines.Results:1.(1) There are significant different between two groups about items including priortreatmental PUF,PST,24 hour urine K-to-Cr ratio and bladder maximum volume.(2)There are significant different among prior treatment,post-treatment of 3 months and6 months about items including PUF,PST,24 hour urine K-to-Cr ratio and bladdermaximum volume.Prior treatmental PUF were significantly higher thanpost-treatmental 3 months and 6 months,whereas PUF have no significant differencebetween post-treatmental 3 months and 6 months.Prior treatmental PST weresignificantly higher than post-treatmental 3 months and 6 months,whereas PST have no significant difference between post-treatmental 3 months and 6 months.Priortreatmental bladder maximum volume were significantly higher than post-treatmental3 months and 6 months,whereas bladder maximum volume have no significantdifference between post-treatmental 3 months and 6 months.(3) There weresignificant positive correlation between PUF and PST before and after treatment (r_S=0.879,r_S=0.747,r_S=0.529).2.There are significant different among prior treatment,post-treatment of 3months and 6 months about APF activity.Prior treatmental APF activities weresignificantly higher than post-treatmental 3 months and 6 months.APF wereisolocated and purified from IC urine with HPLC methods.16.36min peak wasidentified as APF in IC urine samples.3.There are many mast cells infiltrating in mucosa layer through lightmicroscope in IC patients,there are significant difference between two groups.Mastcells in IC group manifestate degranulation in electron microscope,there aresignificant difference between two groups.The expression of IFN-γand IL-2 in ICblood plasm and tissues had no significant difference with normal control.Theexpression of IL-4 and IL-10 in IC blood plasm and tissues had significant differencewith normal controls.The expression of Th2 type cytokines has significantcorrelation with the degree of PUF,which intensifies in the IC of high PUF.Conclusion:1.PUF can screen IC patients,PST can be used for IC final diagnosis.24 hoururine K-to-Cr ratio will not bring pain to patients,but it has lower specificity thanPST and can not take the place of PST.Treatment combined hydrodistention withirrigation of bladder can significantly improve symptom of IC patients.2.Determination of APF activity has higher sensitivity and specificity indiagnosis of IC.It can be a marker for diagnosis and follow-up in IC.3.There lay a lot of mast cells which appear activation in IC bladder tissues,counting for mast cell can help diagnosis and treatment for IC.The expression patternof Th2 type cytokines was predominant in IC blood plasm and bladder tissues,Theexpression of Th2 type cytokines in IC bladder tissues has correlation with the degreeof PUF.