Interstitial cystitis/bladder pain syndrome and glycosaminoglycans replacement therapy.
Interstitial cystitis/bladder pain syndrome and glycosaminoglycans replacement therapy.
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DOI：
10.3978/j.issn.2223-4683.2015.11.04
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发表时间：
2015-12
影响因子：
2
通讯作者：
Cervigni M
中科院分区：
文献类型：
--
作者：
Cervigni M
间质性膀胱炎/膀胱疼痛综合征（IC/BPS）是一种使人衰弱的慢性疾病，其特征是在没有尿路感染的情况下出现不适或复发性腹部和盆腔疼痛。其症状包括不适，膀胱压力增加，膀胱和骨盆区域的敏感性和剧烈疼痛，排尿频率和紧迫性增加，或这些症状的组合。由于这些原因，这种病理学对生活质量有非常负面的影响。IC/BPS的病因仍然没有得到很好的理解，已经制定了不同的假设，包括自身免疫过程，过敏反应，慢性细菌感染，暴露于毒素或饮食元素，以及心身因素。对于IC/BPS的有效和特异性治疗的发现仍然是科学界的挑战，因为缺乏关于诊断的原因和固有困难的共识。最近的一个假设是，IC/BPS可能与膀胱粘膜表面层的破坏以及随后的糖胺聚糖（GAG）损失有关。这类粘多糖具有疏水特性，它们的改变使尿道暴露于许多尿毒性物质。据推测，当这些物质穿透膀胱壁时，在粘膜下层中触发了一条链。为了改善膀胱内衬的完整性和功能，GAG层补充疗法被广泛接受为对常规疗法反应差或不充分的IC/BPS患者的疗法。目前，硫酸软骨素（CS）、肝素、透明质酸（HA）和戊聚糖多硫酸酯（PPS）以及两种GAG（CS和HA）的组合是IC/BPS患者中具有不同有效率的可用物质。有四种不同的市售产品可用于GAG补充，包括CS、肝素、HA和PPS。每种产品都有不同的浓度和剂量配方。最近，CS和HA的组合是最新的市售产品，具有有希望的结果。
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a debilitating chronic disease characterized by discomfort or recurrent abdominal and pelvic pains in the absence of urinary tract infections. Its symptomatology includes discomfort, increased bladder pressure, sensitivity and intense pain in the bladder and pelvic areas, increased voiding frequency and urgency, or a combination of these symptoms. For these reasons, this pathology has a very negative impact on quality of life. The etiology of IC/BPS is still not well understood and different hypotheses have been formulated, including autoimmune processes, allergic reactions, chronic bacterial infections, exposure to toxins or dietary elements, and psychosomatic factors. The finding of an effective and specific therapy for IC/BPS remains a challenge for the scientific community because of the lack of a consensus regarding the causes and the inherent difficulties in the diagnosis. The last recent hypothesis is that IC/BPS could be pathophysiologically related to a disruption of the bladder mucosa surface layer with consequent loss of glycosaminoglycans (GAGs). This class of mucopolysaccharides has hydrorepellent properties and their alteration expose the urothelium to many urinary toxic agents. It has been hypothesized that when these substances penetrate the bladder wall a chain is triggered in the submucosa. In order to improve the integrity and function of the bladder lining, GAG layer replenishment therapy is widely accepted as therapy for patients with IC/BPS who have poor or inadequate response to conventional therapy. Currently, Chondroitin sulfate (CS), heparin, hyaluronic acid (HA), and pentosan polysulphate (PPS), and combinations of two GAGs (CS and HA) are the available substances with different effectiveness rates in patients with IC/BPS. There are four different commercially available products for GAG replenishment including CS, heparin, HA and PPS. Each product has different concentrations and dosage formulations. Recently, a combination of CS and HA is the latest commercially available product with promising results.