Rushton H G, Belman A B, Zaontz M R, Skoog S J, Sihelnik S
Children's National Medical Center, Washington, D.C. 20010, USA.
J Urol. 1996 Aug;156(2 Pt 2):651-5. doi: 10.1097/00005392-199608001-00022.
The relationship of functional bladder capacity as well as other variables to the responsiveness to desmopressin in children with monosymptomatic nocturnal enuresis was investigated.
A total of 95 children 8 to 14 years old with monosymptomatic nocturnal enuresis (6 or more of 14 nights wet) were evaluated in a double-blind study followed by open label crossover extension using 20 to 40 mcg. desmopressin. Evaluated predictors of response included patient age, gender, race, family history, number of baseline wet nights, urine osmolality parameters and maximum functional bladder capacity (as a percent of predicted bladder capacity based on the formula, patient age + 2 x 30 = cc). Responders to desmopressin were classified as excellent (2 or less of 14 nights wet) or good (50% or greater decrease but more than 2 of 14 nights wet) and nonresponders were defined by a less than 50% decrease in wet nights.
Of the 95 patients 25 (29.5%) achieved an excellent response to desmopressin and 18 (18.9%) had a good response for a cumulative response rate of 45.3%. The remaining 52 patients (54.7%) were nonresponders. There were no significant differences between responders and nonresponders in regard to gender, race, positive family history or baseline urine osmolality parameters. Response to desmopressin was associated with older age, fewer baseline wet nights and larger bladder capacity. Patients with a functional bladder capacity greater than 70% predicted bladder capacity were 2 times more likely to respond to desmopressin.
The responsiveness of children with nocturnal enuresis to desmopressin is adversely affected by reduced functional bladder capacity. The results of this study have implications regarding the potential use of combination pharmacotherapy with desmopressin and an anticholinergic for enuretic patients who are nonresponsive to single drug therapy.
研究单纯症状性夜间遗尿症患儿的功能性膀胱容量以及其他变量与去氨加压素反应性之间的关系。
在一项双盲研究中，对95名8至14岁的单纯症状性夜间遗尿症患儿（14个夜晚中有6个或更多夜晚尿床）进行了评估，随后采用20至40微克去氨加压素进行开放标签交叉扩展研究。评估的反应预测因素包括患者年龄、性别、种族、家族史、基线尿床夜晚数、尿渗透压参数以及最大功能性膀胱容量（占根据公式“患者年龄 + 2×30 = 毫升”预测膀胱容量的百分比）。对去氨加压素反应者分为优秀（14个夜晚中尿床2次或更少）或良好（尿床次数减少50%或更多但超过14个夜晚中的2次），无反应者定义为尿床夜晚数减少少于50%。
95名患者中，25名（29.5%）对去氨加压素获得优秀反应，18名（18.9%）获得良好反应，累积反应率为45.3%。其余52名患者（54.7%）为无反应者。在性别、种族、家族史阳性或基线尿渗透压参数方面，反应者与无反应者之间无显著差异。对去氨加压素的反应与年龄较大、基线尿床夜晚数较少和膀胱容量较大有关。功能性膀胱容量大于预测膀胱容量70%的患者对去氨加压素反应的可能性是其他患者的2倍。
夜间遗尿症患儿对去氨加压素的反应性会因功能性膀胱容量降低而受到不利影响。本研究结果对于对单一药物治疗无反应的遗尿症患者联合使用去氨加压素和抗胆碱能药物进行药物治疗的潜在应用具有启示意义。
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