Rittig S, Knudsen U B, Nørgaard J P, Gregersen H, Pedersen E B, Djurhuus J C
Institute of Experimental Clinical Research, University of Aarhus, Denmark.
Scand J Clin Lab Invest. 1991 Apr;51(2):209-17. doi: 10.1080/00365519109091109.
The circadian variation of plasma atrial natriuretic peptide (ANP) in relation to urinary excretion of sodium (UNa) and potassium (UK) as well as clearance of creatinine (Ccrea) was assessed in 15 juvenile patients with enuresis nocturna and compared with 11 age-, sex-, and weight-matched normal subjects. Normal juveniles showed a highly significant diurnal variation (p less than 0.001) of plasma ANP with diurnal peak levels at midnight (0000 hours) and minimum levels at 0400 hours. Enuretic patients showed a similar diurnal rhythmicity with normal levels during day and night. In normals both UNa and UK showed significant diurnal rhythmicity with a marked reduction from daytime to night-time. Although the total diurnal excretions of UNa and UK were similar to normals, patients with enuresis showed abnormal diurnal variation in both UNa (p less than 0.05) and UK (p less than 0.01). The abnormal circadian rhythm of UNa and UK in enuretics seemed to be caused by abnormal tubular handling as similar abnormalities were found in the fractional excretions and as the circadian variation of Ccrea was normal. Especially during the first hours of sleep (2200 hours to 0000 hours), the patients showed polyuria (230 +/- 138 ml vs 116 +/- 58 ml, p less than 0.01), natriuresis (20.9 +/- 16.3 mmol l-1 vs 10.7 +/- 6.8 mmol l-1, p less than 0.01), and kaliuresis (7.3 +/- 6.3 mmol l-1 vs 3.7 +/- 2.3 mmol l-1, p less than 0.05), despite normal levels of plasma ANP. In conclusion, the study describes the diurnal variation of plasma ANP in relation to urinary excretion of sodium and potassium in a juvenile normal population. Patients with nocturnal enuresis show abnormal diurnal rhythmicity in the urinary excretion of sodium and potassium that is not correlated to the plasma levels of ANP.
评估了15例青少年夜遗尿患者血浆心钠素（ANP）的昼夜变化及其与尿钠（UNa）、尿钾（UK）排泄以及肌酐清除率（Ccrea）的关系，并与11例年龄、性别和体重匹配的正常受试者进行比较。正常青少年血浆ANP呈现高度显著的昼夜变化（p＜0.001），午夜（00:00）时达到昼夜峰值水平，04:00时为最低水平。遗尿患者表现出类似的昼夜节律，白天和夜间水平正常。在正常人群中，UNa和UK均呈现显著的昼夜节律，从白天到夜间明显减少。尽管遗尿患者UNa和UK的昼夜总排泄量与正常人相似，但他们的UNa（p＜0.05）和UK（p＜0.01）昼夜变化异常。遗尿患者UNa和UK的异常昼夜节律似乎是由肾小管处理异常引起的，因为在分数排泄中发现了类似异常，且Ccrea的昼夜变化正常。特别是在睡眠的最初几个小时（22:00至00:00），尽管血浆ANP水平正常，但患者仍出现多尿（230±138 ml对116±58 ml，p＜0.01）、利钠（20.9±16.3 mmol·l-1对10.7±6.8 mmol·l-1，p＜0.01）和利尿钾（7.3±6.3 mmol·l-1对3.7±2.3 mmol·l-1，p＜0.05）。总之，该研究描述了青少年正常人群中血浆ANP与尿钠、尿钾排泄相关的昼夜变化。夜间遗尿患者尿钠和尿钾排泄的昼夜节律异常，且与ANP血浆水平无关。
