Pathomechanism of Interstitial Cystitis/Bladder Pain Syndrome and Mapping the Heterogeneity of Disease.
Pathomechanism of Interstitial Cystitis/Bladder Pain Syndrome and Mapping the Heterogeneity of Disease.
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DOI：
10.5213/inj.1632712.356
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发表时间：
2016-11
影响因子：
2.3
通讯作者：
Kuo HC
中科院分区：
文献类型：
--
作者：
Jhang JF;Kuo HC
间质性膀胱炎/膀胱疼痛综合征（IC/BPS）是一种异质性综合征，通常以尿频、尿痛和膀胱疼痛为特征。已经提出了几种病理机制，包括尿路上皮功能障碍、肥大细胞活化、神经源性炎症、自身免疫和隐匿性尿路感染。炎症过程可能改变了尿路上皮稳态的调节，导致膀胱上皮功能障碍。已经探索了IC/BPS的不同表型，包括Hunner和非Hunner型IC、膀胱过敏和伴有和不伴有功能性躯体综合征的膀胱疼痛。在不同的IC表型中也发现了不同的基因表达。尿斑蛋白、硫酸软骨素、粘附蛋白E-cadherin、紧密连接蛋白紧密连接蛋白1在IC/BPS膀胱中的异常表达提示IC/BPS膀胱上皮分化异常。尿或血清中炎性蛋白或细胞因子的分析为IC/BPS亚型提供了另一个诊断基础。IC/BPS在全身功能性躯体综合征和其他盆腔器官疾病中的参与也可细分为IC/BPS亚型。慢性炎症、尿路上皮细胞凋亡增加和尿路上皮功能异常与IC膀胱密切相关。本文综述了近年来关于IC的病理机制的研究，这可能有助于我们绘制疾病的异质性。
Interstitial cystitis/bladder pain syndrome (IC/BPS) is a heterogeneous syndrome which is usually characterized by urinary frequency, nocturia, and bladder pain. Several pathomechanisms have been proposed, including uroepithelial dysfunction, mast cell activation, neurogenic inflammation, autoimmunity, and occult urinary tract infections. It is possible that an inflammatory process alters regulation of urothelial homeostasis and results in dysfunction of the bladder epithelium. Different phenotypes of IC/BPS have been explored including Hunner and non-Hunner type IC, hypersensitive bladder, and bladder pain both with and without functional somatic syndrome. Different gene expressions have also been found in different IC phenotypes. Abnormal expressions of uroplakin, chondroitin sulfate and adhesive protein E-cadherin, tight junction protein zonula occludens-1 in IC/BPS bladder suggest abnormal epithelial differentiation in this bladder disease. Analysis of inflammatory proteins, or cytokines in the urine or serum provides another diagnostic foundation forIC/BPS subtypes. The involvement of IC/BPS in systemic functional somatic syndrome and other pelvic organ diseases might also subdivide subtypes of IC/BPS. Chronic inflammation, increased urothelial apoptosis, and abnormal urothelial function are closely associated in IC bladders. This article reviews recent research on the pathomechanisms of IC, which might help us in mapping the heterogeneity of the disease.