Clinical Efficacy and Changes of Urothelial Dysfunction after Repeated Detrusor Botulinum Toxin A Injections in Chronic Spinal Cord-Injured Bladder.
Clinical Efficacy and Changes of Urothelial Dysfunction after Repeated Detrusor Botulinum Toxin A Injections in Chronic Spinal Cord-Injured Bladder.
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DOI：
10.3390/toxins8060164
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发表时间：
2016-05-30
期刊：
影响因子：
4.2
通讯作者：
Kuo HC
中科院分区：
文献类型：
--
作者：
Chen SF;Chang CH;Kuo HC
慢性脊髓损伤（SCI）可引起膀胱排尿功能障碍。本研究旨在探讨脊髓损伤（SCI）伴神经源性逼尿肌过度活动（NDO）患者反复逼尿肌注射肉毒毒素A（BoNT-A）对尿路上皮功能障碍的治疗作用。20例慢性骶上脊髓损伤伴NDO患者入组。患者每6个月接受300 U BoNT-A注射到逼尿肌中。在基线和每次BoNT-A治疗后6个月，通过膀胱镜活检评估尿道炎。免疫荧光染色尿路上皮功能障碍，包括E-钙粘蛋白，闭锁小带-1（ZO-1），类胰蛋白酶肥大细胞活性，和尿路上皮细胞凋亡进行了研究。在基线和每次治疗后6个月之间比较BoNT-A注射后尿路上皮功能障碍参数的结果。重复注射300 U BoNT-A显示逼尿肌压力与基线相比持续降低。在三次重复BoNT-A逼尿肌注射后，在重复BoNT-A治疗后，发现E-cadherin（p = 0.042）和ZO-1（p = 0.003）表达的分布显著更大，但尿路上皮细胞凋亡和肥大细胞活化没有显著变化。尿道上皮功能障碍，如SCI患者膀胱中的粘附和连接蛋白浓度，在BoNT-A治疗的三个重复周期后恢复。治疗效果持续。然而，SCI后的尿路上皮炎症和细胞凋亡在三次重复BoNT-A注射后没有显著改善。
Chornic spinal cord injury (SCI) will induce bladder urothelium dysfunction. This study investigated the therapeutic effects on urothelial dysfunction after repeated detrusor injections of onabotulinumtoxinA (BoNT-A) in SCI patients with neurogenic detrusor overactivity (NDO). Twenty chronic suprasacral SCI patients with NDO were enrolled. The patients received 300 U BoNT-A injection into the detrusor every six months. The urothelium was assessed by cystoscopic biopsy at baseline and six months after each BoNT-A treatment. Immunofluorescence staining for urothelial dysfunction, including E-cadherin, zonula occludens-1 (ZO-1), tryptase for mast cell activity, and urothelial apoptosis were investigated. The outcome of urothelial dysfunction parameters after BoNT-A injection were compared between baseline and six months after each treatment. Repeated 300 U BoNT-A injections showed a sustained decrease of detrusor pressure compared with baseline. After three repeated BoNT-A detrusor injections, significantly greater distributions of E-cadherin (p = 0.042) and ZO-1 (p = 0.003) expressions, but no significant changes, of urothelial apoptosis and mast cell activation were found after repeated BoNT-A therapy. Urothelial dysfunction, such as adhesive and junction protein concentrations in SCI patients’ bladders, recovered after three repeated cycles of BoNT-A treatment. The therapeutic effects sustained. However, urothelial inflammation and apoptosis after SCI were not significantly improved after three repeated BoNT-A injections.