Fjellestad-Paulsen A, Laborde K, Kindermans C, Czernichow P
Department of Paediatric Endocrinology and Diabetes, Hôpital des Enfants Malades, Paris, France.
Acta Paediatr. 1993 Sep;82(9):752-7. doi: 10.1111/j.1651-2227.1993.tb12552.x.
The aim of the present study was to investigate the hormonal control of water-balance in children with diabetes insipidus and to assess safety and efficacy of long-term treatment with oral dDAVP. Plasma atrial natriuretic peptide, plasma renin activity, aldosterone, plasma and urinary cyclic 3'5'-guanosine monophosphate and urinary prostaglandin E2 were measured in eight patients (aged 3-21 y) with central diabetes insipidus. At baseline, 12 h after the last dDAVP dose, patients had hypotonic polyuria but normal plasma sodium concentrations and plasma osmolality relative to a control group. The mean plasma atrial natriuretic peptide concentration in patients (26.2 +/- 2.6 pg/ml) tended to be lower than in controls (36.5 +/- 8.2 pg/ml, mean +/- SEM), although the difference was not significant. Plasma cyclic 3'5' guanosine monophosphate was higher in controls (6.0 +/- 0.6 pmol/ml, mean +/- SEM) than in patients (3.8 +/- 0.3 pmol/ml). Aldosterone, plasma renin activity, urinary cyclic guanosine monophosphate and urinary prostaglandin E2 were similar in the two groups. During 3 h following dDAVP administration, atrial natriuretic peptide levels did not change in patients but decreased significantly in controls to 23.0 +/- 4.0 pg/ml. No adverse reactions, or circulating antibodies against dDAVP, were observed after 3.5 years of oral dDAVP treatment. The average oral dDAVP dosage was similar after 1 and 3.5 years of treatment (906 +/- 406 micrograms/24 h, mean +/- SD). Water-balance is not detectably different from normal in correctly treated diabetes insipidus patients in terms of plasma atrial natriuretic peptide, plasma renin activity and aldosterone levels. Long-term oral dDAVP treatment is safe and efficacious.
本研究的目的是调查尿崩症患儿水平衡的激素调控情况，并评估口服去氨加压素长期治疗的安全性和有效性。对8例（年龄3 - 21岁）中枢性尿崩症患者测定了血浆心钠素、血浆肾素活性、醛固酮、血浆和尿中环磷酸鸟苷以及尿前列腺素E2。在基线时，即最后一剂去氨加压素给药12小时后，患者出现低渗性多尿，但相对于对照组，血浆钠浓度和血浆渗透压正常。患者的平均血浆心钠素浓度（26.2±2.6 pg/ml）虽低于对照组（36.5±8.2 pg/ml，均值±标准误），但差异无统计学意义。对照组的血浆环磷酸鸟苷（6.0±0.6 pmol/ml，均值±标准误）高于患者（3.8±0.3 pmol/ml）。两组的醛固酮、血浆肾素活性、尿环磷酸鸟苷和尿前列腺素E2相似。在给予去氨加压素后的3小时内，患者的心钠素水平未变化，而对照组显著下降至23.0±4.0 pg/ml。口服去氨加压素治疗3.5年后未观察到不良反应或抗去氨加压素循环抗体。治疗1年和3.5年后的平均口服去氨加压素剂量相似（906±406微克/24小时，均值±标准差）。就血浆心钠素、血浆肾素活性和醛固酮水平而言，正确治疗的尿崩症患者的水平与正常情况无明显差异。长期口服去氨加压素治疗安全有效。
