Alon U, Chan J C
Am J Nephrol. 1985;5(1):9-13. doi: 10.1159/000166896.
The effects of treatment with hydrochlorothiazide combined with amiloride were compared to hydrochlorothiazide treatment alone in 2 brothers with congenital nephrogenic diabetes insipidus. Whereas both modalities of treatment resulted in reduction in voiding frequency and urine volume, decrease in daily fluid intake and increase in urine osmolality, the two-drug combination was found to be superior to hydrochlorothiazide alone by preventing urinary potassium losses, hypokalemia, and alkalosis. It was also found that amiloride had a certain additive effect to the thiazide in terms of increasing initial urinary sodium excretion, reducing urine volume and free water clearance, and lowering serum sodium concentration and osmolality. Similar comparison of the hydrochlorothiazide-amiloride regimen to treatment with the hydrochlorothiazide-tolmetin combination in 1 of the patients revealed that the effectiveness of both diuretic modalities was close with slight advantage of the former. Treatment of the 2 patients for 10 months with hydrochlorothiazide and amiloride showed no adverse effects and consistent reduction in fluid intake and urine volume. It is concluded that the hydrochlorothiazide-amiloride regimen is superior to hydrochlorothiazide alone and can be a satisfactory alternative to the hydrochlorothiazide-prostaglandin synthetase inhibitor combination in the treatment of congenital nephrogenic diabetes insipidus.
在2名先天性肾性尿崩症兄弟中，比较了氢氯噻嗪联合阿米洛利治疗与单独使用氢氯噻嗪治疗的效果。虽然两种治疗方式均导致排尿频率和尿量降低、每日液体摄入量减少以及尿渗透压升高，但发现联合使用这两种药物优于单独使用氢氯噻嗪，因为它可防止尿钾丢失、低钾血症和碱中毒。还发现，在增加初始尿钠排泄、减少尿量和自由水清除率以及降低血清钠浓度和渗透压方面，阿米洛利对噻嗪类药物有一定的相加作用。在其中1例患者中，将氢氯噻嗪 - 阿米洛利方案与氢氯噻嗪 - 托美丁联合治疗进行类似比较，结果显示两种利尿方式的有效性相近，前者略有优势。用氢氯噻嗪和阿米洛利治疗这2例患者10个月，未显示出不良反应，且液体摄入量和尿量持续减少。结论是，氢氯噻嗪 - 阿米洛利方案优于单独使用氢氯噻嗪，并且在先天性肾性尿崩症的治疗中，它可以成为氢氯噻嗪 - 前列腺素合成酶抑制剂联合治疗的令人满意的替代方案。
