Steffens J, Netzer M, Isenberg E, Alloussi S, Ziegler M
Department of Urology, University of Saarland, Homburg, FRG.
Eur Urol. 1993;24(3):366-70. doi: 10.1159/000474330.
The lack of circadian rhythmicity of plasma arginine vasopressin (AVP) in primary nocturnal enuresis (PNE) in some children is known. The original test protocol is time-consuming and needs excellent compliance by children and parents. The goals of the presented study are the introduction of a simple screening test and the evaluation of the response of treatment using intranasal synthetic vasopressin. Fifty-five children (aged 8.2 +/- 3.1 years) with PNE and 15 children (aged 7.9 +/- 2.4 years) of a control group were investigated. Using a standardized protocol, AVP levels were measured by radioimmunoassay (RIA) under controlled water intake 3 times per day over a period of 72 h. Fourteen of 55 tested children (25.5%) with PNE had a significant decrease in nocturnal AVP when compared to the control group. We measured also an increased nocturnal urine volume and a lower urine osmolality in this enuretic group. Eight of 14 patients (57.1%) with plasma AVP deficiency (AVPD) also had bladder instability. Nine of 14 patients (64.3%) with AVPD with or without concomitant bladder instability were totally dry during desmopressin treatment, but only 2 (14.3%) remained dry after discontinuation of treatment. Our data suggest that nocturnal urine osmolality measurement may reflect AVPD and predict a positive treatment outcome.
已知部分原发性夜间遗尿症（PNE）患儿血浆精氨酸加压素（AVP）缺乏昼夜节律性。原始的检测方案耗时且需要患儿及其家长有良好的依从性。本研究的目的是引入一种简单的筛查试验，并评估使用鼻内合成加压素治疗的反应。对55名患有PNE的儿童（年龄8.2±3.1岁）和15名对照组儿童（年龄7.9±2.4岁）进行了调查。采用标准化方案，在72小时内，每天控制饮水3次，通过放射免疫分析法（RIA）测量AVP水平。与对照组相比，55名接受检测的PNE患儿中有14名（25.5%）夜间AVP显著降低。我们还测量了该遗尿组夜间尿量增加和尿渗透压降低。14名血浆AVP缺乏症（AVPD）患者中有8名（57.1%）也存在膀胱不稳定。14名AVPD患者中有9名（64.3%）无论有无膀胱不稳定，在去氨加压素治疗期间完全无遗尿，但停药后只有2名（14.3%）仍无遗尿。我们的数据表明，夜间尿渗透压测量可能反映AVPD并预测治疗的阳性结果。
