原发性遗尿症与血清血管升压素的相关性

Relativity between Serum Antidiuretic Hormone Level and Primary Nocturnal Enuresis in Children

目的探讨血清血管升压素(ADH)和原发性遗尿症(PNE)发病的相关性。方法用酶联免疫吸附法前瞻性测定18例(男10例,女8例;年龄5～14岁,平均8.06岁)PNE患儿和20例5～14岁(平均年龄8.15岁)(男10例,女10例)健康儿童的白天(3Pm)及夜间(1Am)血清ADH水平,并测定同时间血渗透压。结果对照组1Am的ADH水平较3Pm的ADH水平明显上升,差异具有显著性(P=0.002);病例组在1Am和3Pm的ADH水平差异无显著性(P=0.834);与对照组比较,病例组3Pm的ADH水平差异无显著性(P=1.0),而1Am则明显降低(P=0)。晨尿(6～7Am)渗透压病例组明显低于对照组(P=0.023),而白天尿(3Pm)渗透压二组之间差异无显著性(P=1.0);而血渗透压二组均相对稳定(P=0.430,0.578)。结论PNE患儿存在夜间ADH分泌不足。

Objective To explore the role of serum antidiuretic hormone（ADH） in the pathogenesis of primary nocturnal enuresis（PNE） and its relativity to this disease in children. Methods This study was prospectively planned to detect serum ADH and serum osmolality at 3 Pm and 1 Am and morning（6 -7 Am）and afternoon（3 Pro）urine osmolality in 2 groups as follows： PNE group contained 18 patients[ 10 males,8 females,aged 5 to 14 years, mean 8.06 years] who had persistent bed wetting symptom with no constitutional lesions early from infancy up to more than 5 years old, and normal control group contained 20 healthy children without bed wetting history [ 10 male, 10 female, aged 5 to 14 years, mean 8.15 years]. Results In normal controls, the peak value of ADH level of 1 Am（ ADH1 ） actually occurred and was much higher than serium ADH level of 3 Pm（ADH15 ）. There appeared that a very significant difference existed between these 2 levels （ P = 0. 002 ）. In PNE group, however,serum ADH1 and ADH15 levels were nearly in a same range and no significant difference could be observed with respectively,P =0. 834）. It appeared that ADH1 of PNE group was much lower than that of normal controls and there existed a very significant difference between ADH1 levels （ P = 0） and no significant difference could be observed between ADH15 levels of these 2 groups （ P = 1.0 ）. The osmolality of first morning urine specimen in PNE group was significantly lower than normal control （P = 0. 023 ） and no significant difference could be observed between afternoon urine of the 2 groups （ P = 1.0 ）. Serum osmolality was no significant difference in the 2 groups （ P = 0. 806）. Conclusion An apparently decreased secretion of serum ADH at midnight may be one of the causes of bedwetting symptom in children with PNE.