中枢性尿崩症与实验室诊断

Central Diabetes Insipidus and Laboratory Diagnosis

报告中枢性尿崩症140例,男64女76例。青年发病125例(89.3％),平均病程4.2年,最长31年。特发性尿崩症51例(36.4％),继发性89例(63.6％)。140例中有暂时性尿崩症4例(2.8％),部分性尿崩症12例(8.7％),其余124例为典型而持久的中枢性尿崩症(88.5％)。本病患者24小时尿量多达8000～10000ml,尿比重降低至1.000～1.008,部分性尿崩症患者可达1.006～1.014。目前以血浆放射免疫法测定血浆精氨酸血管加压素(AVP)诊断本病最为简便可靠,本文测20例AVP值(x±s)为2.85±1.38ng/L,正常值为13.6±9.4ng/L,患者呈显著性降低(P<0.001),其中6例部分性尿崩症AVP值为3.51±1.44ng/L(P<0.001)。因此,血浆AVP值测定对于诊断非渗透性多尿疾病有较大意义。

One hundred forty patients of central diabetes msipidus(CDI) (64 males and 76 females) were reported. The mean course of the disease was 4.2 years. Of these patients, 51 cases were primary diabetes insipidus (36.4%), 89 cases secondary diabetes insipidus (63. 6% ), 124 cases (88. 5%) long term typical GDI. 12 cases (8. 7%) partisl GDI and 4 cases (2.8%) temporary GDI. The causes of the disease included cranial tumor, craniocerebral injury, intracramal inflammation, hy-pothalamic syndrome, tuberculosis, syphilis, and chronic fluorosis. The laboratory findings showed that 24 hours urinary output exceeded 4 liters, 55. 8% patients had urinary out put about 8-12 liters. The specific gravity of the urine was 1. 000-1. 014. The simple hyperosmolar NaCl solution test of 42 cases showed that the mean of 2 hours urinary volume was significantly increased to 795. 5±310. 4ml(P<3. 01). Urinary osmolahty determination showed significantly decreased (P<0. 01). Water deprivation test and Hickey - Hare test were helpful to diagnose GDI-The mean concentration of plasma RIA AVP was 2. 8±1. 4ng/L(n-20, P<0. 001) and significantly decreased. Among them, there were 6 cases of partial diabetes insipidus and their mean level of plasma AVP was 3. 5±1. 4ng/L(P<0. 001). The plasma AVP measurement is a very useful and noninvasive method,it can be helpful for diagnosis and differential diagnosis of polyuria or hy-pouresis diseases,such as diabetes insipidus,wolffram syndrome,and S1ADH.