• 作者： 郭漢崇
• 作者服務機構： 慈濟綜合醫院泌尿科
• 中文摘要： 為了探討紅辣椒素對於正常及脊髓損傷人類之膀胱收縮力之影響，作者利用離體肌肉條進行肌肉收縮研究。本研究共取用十位非脊髓損傷膀胱之正常部分，以及八位脊髓損傷病人的膀胱做為比較研究。在手術中取下一塊逼尿肌，並分成八條肌肉條。其中四條以1~1000μM紅辣椒素處理，在處理前後則以電場刺激及bethanechol做收縮力之測定。另外四條事先以40 nmole之[　(方程式無法摘錄)　]-substance P (spantide)浸泡30分鐘，再重覆以上之實驗。結果顯示紅辣椒素對正常及脊髓損傷之逼尿肌具有濃度相關之收縮反應，但在不同濃度的紅辣椒素處理過十分鐘後，低濃度紅辣椒素會部分抑制逼尿肌之收縮力，而高濃度之紅辣椒素(1000 μm)則幾乎完全阻斷逼尿肌之收縮力。紅辣椒素引發的肌肉收縮在正常膀胱較強，但其對肌肉收縮力所造成之抑制收縮程度則在正常及脊髓損傷無顯著的差異。在加入spantide後，肌肉對紅辣椒素之收縮反應，以及隨後產生的抑制收縮作用，並無明顯的差異，顯示紅辣椒素對逼尿肌的收縮作用主要不是經由NK受器，而是直接作用於肌肉細胞。而這些肌肉條在全部實驗後再度加入紅辣椒素，並無法引發原有之收縮反應，甚至在洗完紅辣椒素之後亦不能恢復原有之肌肉收縮力。這些結果顯示在高濃度紅辣椒素直接施於逼尿肌時，會產生直接的細胞毒性或神經毒性，使之收縮力降低或消失。　　近年來臨床上廣泛使用膀胱內高濃度紅辣椒素，灌注於脊髓損傷病人，以治療逼尿肌反射亢進。此種對於肌肉細胞之毒性應特別注意，以免在長期治療後造成無法恢復之結果。
• 英文摘要： In order to investigate the effects of capsaicin on human detrusor contractility in both normal andspinal cord injury (SCI) bladders, a detrusor contractility study was performed in 10 normal and 8 SCI pa-tients using isolated muscle strips. Eight bladder muscle strips were harvested from each patient undergoingsurgery. Four strips were treated with capsaicin of 1-1000 M, and electrical field stimulation andbethanechol were applied to the strips before and after capsaicin administration. The other four stripswere pretreated with 40nmole [ (方程式無法摘錄) ]-Substance P (spantide) and then were underwentthe same procedure. The results showed that capsaicin induced a dose-dependent increase in muscle tensionon the human detrusor in both normal and SCI bladders. After treatment with varying concentrations ofcapsaicin for 10 minutes, low doses of capsaicin partially depressed detrusor contractility under both electri-cal and bethanechol stimulation while high doses of up to 1000 M almost totally blocked detrusor con-tractility. The initial contractile effect of capsaicin was higher in normal bladders but the final depressanteffect did not show any difference between normal and SCI bladders. With addition of spantide, the initialcontractile effect and the final depressant effect of capsaicin remained the same, indicating that the contractileeffects of capsaicin were not mainly through NK receptors but directly on muscle cells. Consecutive appli-cation of capsaicin to the same strip could not reproduce the contractile response. After washing free ofcapsaicin, the detrusor contractility under electrical stimulation and bethanechol was not reversible. A directneurotoxic or cytotoxic effect could be found after high concentration capsaicin administration. In treatingpatients suffering from detrusor hyperreflexia using intravesical capsaicin instillation, this effect should beconsidered to prevent irreversible damage to the urinary bladder.
• 中文關鍵字： capsaicin; micturition; human bladder.
• 英文關鍵字： --