香兰素类药物在泌尿系统疾病中的应用。

Harris E Foster, AeuMuro G Lake
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引用次数: 22

摘要

膀胱是一个富含香草蛋白靶点的器官:密集的无髓c纤维部分负责膀胱感觉和对有害刺激的反应。辣椒素和树脂素毒素(RTX)等药物与VR1香草样受体亚型相互作用,最初使c纤维兴奋,随后使其脱敏。本章研究了描述香草受体激动剂在以下泌尿系统疾病治疗中的应用的文献:神经性膀胱(NGB)、膀胱过度活动(OAB)和间质性膀胱炎/膀胱疼痛综合征(IC/PBS)。使用Pubmed检索相关文献,关键词为“辣椒素”、“树脂干扰素(RTX)”、“神经源性膀胱”、“过度活动膀胱(OAB)”、“间质性膀胱炎”、“膀胱疼痛综合征”。我们回顾了比较香草受体激动剂和安慰剂的随机对照试验和英文文献。我们的结论是,辣椒素和RTX似乎确实为神经源性膀胱患者提供了一些可接受的治疗结果,尽管需要更大规模的研究来证实这一点。虽然在一些研究中显示了有效性,但目前尚不能推荐将香兰素类药物作为OAB患者的常规用药,因为需要置管可能导致风险大于治疗的益处。同样,对于BPS的治疗,香草受体激动剂缺乏强有力的疗效或耐受性证据;需要更大规模的研究来确定它们的作用。然而,了解香草素如何能够影响这些疾病,可能有助于进一步阐明其潜在的病理生理过程。
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Use of vanilloids in urologic disorders.

The bladder is an organ rich in vanilloid targets: dense unmyelinated c-fibers partially responsible for bladder sensation and response to noxious stimuli. Drugs such as capsaicin and resiniferatoxin (RTX) interact with the VR1 vanilloid receptor subtype to initially excite then subsequently desensitize the c-fibers. This chapter examines the literature describing the use of vanilloid receptor agonists in the treatment of the following urological disorders: neurogenic bladder (NGB), overactive bladder (OAB), and interstitial cystitis/painful bladder syndrome (IC/PBS). Review of the literature was performed using Pubmed and the following key words "capsaicin," "resiniferatoxin (RTX)," and "neurogenic bladder," "overactive bladder (OAB)," and "interstitial cystitis," "painful bladder syndrome." Articles focusing on randomized trials comparing intravesical administration of a vanilloid receptor agonist to placebo and those in English were reviewed. We conclude that capsaicin and RTX do appear to provide some acceptable treatment results in patients with neurogenic bladder, though larger studies are needed to confirm this. Although efficacy has been shown in some studies, currently the use of vanilloids cannot be recommended for routine use in patients with OAB as the need for catheterization may cause the risk to outweigh the benefit of treatment. Similarly, for the treatment of BPS, vanilloid receptor agonists lack strong evidence for efficacy or tolerability; larger studies are needed to define their role. Understanding how vanilloids are able to impact these disorders, however, may help further elucidate their underlying pathophysiological processes.

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