Sulyok E, Adamovits K, Worgall S, Rascher W
County Children's Hospital, Pécs, Hungary.
Biol Neonate. 1997;72(6):352-62. doi: 10.1159/000244505.
The present study was undertaken to define the possible role of endogenous ouabain-like substance (EOLS) in controlling renal excretory pattern, in mediating the renal responses to furosemide and in inducing endocrine reactions in furosemide-treated neonates. Ten newborn infants with mean birthweight of 2,752 g and mean gestational age of 37.1 weeks were given furosemide in a dose of 1 mg/kg. Prior to and following furosemide therapy, urine was collected for a period of 12 h and analyzed for creatinine, osmolality, sodium and potassium, as well as for EOLS, arginine vasopressin (AVP), aldosterone and endothelin-1 (ET-1). In response to furosemide administration, urine flow rate and urinary osmolar, sodium and potassium excretion increased significantly, whereas creatinine excretion remained unchanged. Furthermore, following furosemide therapy, urinary excretion of EOLS (148.7 +/- 70.8 vs. 200.1 +/- 98.1 pg/kg/h) and AVP (19.5 +/- 5.4 vs. 27.8 +/- 7.8 pg/kg/h) tended to increase, whereas ET-1 (36.0 +/- 5.6 vs. 61.4 +/- 8.7 fmol/kg/h, p < 0.01) and aldosterone (507 +/- 120 vs. 751 +/- 203 ng/kg/h, p < 0.05) increased significantly. Prior to furosemide, urinary EOLS excretion was found to correlate positively with diuresis (r = 0.80, p < 0.01), sodium (r = 0.91, p < 0.001), creatinine (r = 0.75, p < 0.001), osmolar (r = 0.96, p < 0.001), ET-1 (r = 0.90, p < 0.001) and AVP (r = 0.92, p < 0.001) excretion. After furosemide, urinary EOLS excretion significantly correlated only with diuresis (r = 0.69, p < 0.05), ET-1 (r = 0.77, p < 0.01) and AVP (r = 0.92, p < 0.001). Urinary EOLS proved to be independent of aldosterone excretion irrespective of furosemide administration. It is concluded that urinary EOLS excretion is closely related to neonatal renal excretory pattern and it may have a role in controlling diuresis and natriuresis. The renal response to furosemide appears to be independent of EOLS, although interdependent endocrine reactions can be induced by furosemide which may modulate the production rate and urinary excretion of EOLS.
本研究旨在确定内源性哇巴因样物质（EOLS）在控制肾脏排泄模式、介导肾脏对呋塞米的反应以及诱导呋塞米治疗的新生儿内分泌反应中可能发挥的作用。选取了10名平均出生体重为2752g、平均胎龄为37.1周的新生儿，给予1mg/kg剂量的呋塞米。在呋塞米治疗前后，收集12小时尿液，分析肌酐、渗透压、钠、钾以及EOLS、精氨酸加压素（AVP）、醛固酮和内皮素-1（ET-1）。给予呋塞米后，尿流率以及尿渗透压、钠和钾排泄显著增加，而肌酐排泄保持不变。此外，呋塞米治疗后，EOLS（148.7±70.8对200.1±98.1pg/kg/h）和AVP（19.5±5.4对27.8±7.8pg/kg/h）的尿排泄量有增加趋势，而ET-1（36.0±5.6对61.4±8.7fmol/kg/h，p<0.01）和醛固酮（507±120对751±203ng/kg/h，p<0.05）显著增加。在使用呋塞米之前，发现尿EOLS排泄与利尿（r=0.80，p<0.01）、钠（r=0.91，p<0.001）、肌酐（r=0.75，p<0.001）、渗透压（r=0.96，p<0.001）、ET-1（r=0.90，p<0.001）和AVP（r=0.92，p<0.001）排泄呈正相关。使用呋塞米后，尿EOLS排泄仅与利尿（r=0.69，p<0.05）、ET-1（r=0.77，p<0.01）和AVP（r=0.92，p<0.001）显著相关。无论是否给予呋塞米，尿EOLS排泄均与醛固酮排泄无关。研究得出结论，尿EOLS排泄与新生儿肾脏排泄模式密切相关，可能在控制利尿和利钠中发挥作用。肾脏对呋塞米的反应似乎与EOLS无关，尽管呋塞米可诱导相互依赖的内分泌反应，这可能调节EOLS的产生速率和尿排泄。
