Rushton H G, Belman A B, Zaontz M, Skoog S J, Sihelnik S
Children's National Medical Center, Walter Reed Army Medical Center, Washington, D.C., USA.
J Urol. 1995 Aug;154(2 Pt 2):749-53. doi: 10.1097/00005392-199508000-00112.
To determine if urine osmolality parameters can predict whether children with primary monosymptomatic nocturnal enuresis will respond to desmopressin, we conducted a prospective, double-blind, placebo-controlled study in 96 children 8 to 14 years old. Following a 2-week baseline screening interval patients with at least 6 of 14 net nights were randomized to double-blind regimens of desmopressin or placebo. Urine specimens for osmolality were collected at 6 p.m. and 6 a.m. on 3 consecutive days during the baseline and the 2, 14-day treatment periods. A significantly greater proportion of desmopressin treated children had an excellent (2 or fewer wet nights in 14 days) or good (greater than 50% reduction in wet nights) response compared with placebo treated children (p = 0.004 and p = 0.002 for treatment periods 1 and 2, respectively). Children treated with desmopressin reported a significantly lower number of wet nights than placebo treated children during both treatment periods (p = 0.0258 and p = 0.0136, respectively). Children treated with desmopressin had a significantly higher 6 a.m. urine osmolality during both treatment periods and a higher 6 a.m.-to-6 p.m. osmolality ratio (p = 0.004) in the first treatment period compared with the placebo group. Within the desmopressin treatment group clinical responders had a higher 6 a.m. urine osmolality and 6 a.m.-to-6 p.m. urine osmolality ratio than nonresponders during both treatment periods but these differences did not achieve statistical significance. In conclusion, treatment with desmopressin is associated with a significant decrease in the number of wet nights, and a significant increase in nocturnal urine osmolality and nocturnal/diurnal urine osmolality ratios. However, clinical response was not predictable based on baseline or treatment osmolality parameters.
为了确定尿渗透压参数是否能预测原发性单症状性夜间遗尿症患儿对去氨加压素的反应，我们对96名8至14岁的儿童进行了一项前瞻性、双盲、安慰剂对照研究。在为期2周的基线筛查期后，14个净夜间至少有6个尿床的患者被随机分为接受去氨加压素或安慰剂的双盲治疗方案。在基线期以及2个为期14天的治疗期内，连续3天在下午6点和上午6点采集尿渗透压标本。与接受安慰剂治疗的儿童相比，接受去氨加压素治疗的儿童中，有显著更高比例的患儿有良好（14天内尿床2个或更少夜间）或较好（尿床次数减少超过50%）的反应（治疗期1和治疗期2的p值分别为0.004和0.002）。在两个治疗期内，接受去氨加压素治疗的儿童报告的尿床次数均显著低于接受安慰剂治疗的儿童（p值分别为0.0258和0.0136）。与安慰剂组相比，接受去氨加压素治疗的儿童在两个治疗期内上午6点的尿渗透压均显著更高，且在第一个治疗期内上午6点至下午6点的渗透压比值更高（p = 0.004）。在去氨加压素治疗组中，临床有反应者在两个治疗期内上午6点的尿渗透压和上午6点至下午6点的尿渗透压比值均高于无反应者，但这些差异未达到统计学显著性。总之，去氨加压素治疗与尿床次数显著减少、夜间尿渗透压以及夜间/日间尿渗透压比值显著增加相关。然而，基于基线或治疗期渗透压参数无法预测临床反应。
