No Correlation between <i>AVPR</i>1A Promoter Polymorphisms and Prepulse Inhibition in Patients with Nocturnal Enuresis

Introduction: A correlation between AVPR1A promoter polymorphisms and prepulse inhibition (PPI) of startle reflexes has been described in healthy adults. Many children with nocturnal enuresis (NE) have a reduced PPI and treatment with desamino arginine vasopressin (dDAVP), a ligand of the arginine vasopressin receptor 1A (AVPR1A), and both improve clanical symptoms and significantly increase PPI. Methods: In 17 children (median 9.1 years, range 6.4-17.3) with NE, promoter repeats within the RS1 and RS3 regions of AVPR1A were quantified and correlated to PPI (native and age-adjusted). Results: No direct correlation was found between the number of promoter repeats at RS1 and PPI (correlation coefficient—0.240, p = 0.346) or RS3 and PPI (correlation coefficient—0.0192, p = 0.936), with no change through age-adjustment of PPI. The different RS3 length subgroups did not show differences in PPI, nor did differentiation of NE according to clinical subtype or treatment response to dDAVP show differences in the number of promoter repeats. Conclusion: The missing reproducibility of the correlation between AVPR1A promoter polymorphisms and PPI in a group with wide range of PPI suggests a more complex interaction. Therefore, further investigations are needed to analyze this very plausible interaction. Conditions with a reduced PPI, such as enuresis, schizophrenia or autism, are particularly interesting for this research.

Management of nocturnal enuresis-myths and facts

Nocturnal enuresis often causes considerable distress or functional impairment to patient and their parents necessitating a multidisciplinary approach from paediatrician, paediatric nephrologist, urologists and psychiatrist. Mechanisms of monosymptomatic nocturnal enuresis are mainly nocturnal polyuria, bladder overactivity and failure to awaken from sleep in response to bladder sensations. Goal oriented and etiology wise treatment includes simple behavioral intervention, conditioning alarm regimen and pharmacotherapy with desmopressin, imipramine and anticholinergic drugs. Symptoms often recurs requiring change over or combination of different modes of treatment.

Mechanism of Xingshen Zhiyi prescription in the treatment of enuresis based on network pharmacology

Objective:To explore the mechanism of Xingshen Zhiyi Recipe(XSZYF)in the treatment of Nocturnal Enuresis(NE)based on network pharmacology.Methods:TCMSP,DrugBank databases,PubMed and CNKI were used to obtain the active ingredients and corresponding targets of XSZYF.NE targets were obtained from GeneCard and OMIM databases.Cytoscape software was used to construct a drug-disease-target network model.The analysis was performed.The protein interaction network(PPI)was constructed using the STRING database.The gene ontology functional annotation(GO)and the Tokyo Genomic Encyclopedia(KEGG)pathway enrichment analysis were performed on key targets using the DAVID online tool.Surflex docking software was used for the analysis.Docking of key active ingredients and key targets to verify the results of network analysis.Results:199 gene targets of XSZYF were obtained,and 2486 gene targets of NE.Network analysis results showed that the key targets of XSZYF for treating NE include CHRM3,CHRM2,ADRB3,etc.Involved in regulating neuroactive ligand-receptor interactions,calcium signaling pathways,etc.Conclusion:This study revealed the material basis and action mechanism of XSZYF in treating NE from the perspective of network pharmacology.

Current perspectives on the correlation of nocturnal enuresis with obstructive sleep apnea in children

Background Obstructive sleep apnea (OSA) and nocturnal enuresis (NE) are common clinical problems in children.OSA and NE are thought to be interrelated,but the exact pathophysiological mechanisms are not yet clear.This review aims to explain the possible pathogenesis of NE in children with OSA.Date sources We have retrieved all relevant original articles from Database that have been published so far,including the prevalence studies of NE and OSA in children,sleep characteristic studies that use polysomnography (PSG) to focus on children with NE,and studies on the relationship between OSA and NE.Results Clinical studies have revealed that the risk of NE in children with OSA was increased compared with that of their healthy peers.This increased risk may be associated with sleep disorders,bladder instability,detrusor overactivity,nocturnal polyuria,endocrine and metabolic disorders,and inflammation.Conclusions Cardiopulmonary and renal reflex-induced neuroendocrine disorder may play an important role in the mechanism of NE in children with OSA,but this remains to be confirmed by animal studies.Other causes such as oxidative stress and inflammatory responses need to be further researched.

中国儿童青少年遗尿症患病率及影响因素的Meta分析

背景遗尿症是儿科常见疾病之一,近年来,遗尿症对儿童青少年身心健康造成了极大的威胁,严重影响患儿的生活质量,给社会和家庭带来严重的负担。目前,关于儿童青少年遗尿症的影响因素还存在争议,且国内外鲜见相关的系统评价。目的利用Meta分析探讨国内儿童青少年遗尿症的患病率和影响因素。方法计算机检索中国知网(CNKI)、万方数据知识服务平台(Wanfang Data)、维普网(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、Embase、Web of Science、Cochrane Library数据库中的相关研究,检索时间从建库至2024年5月。由2名研究者独立筛选并交叉核对,横断面研究采用美国医疗保健研究与质量机构进行评估,采用Stata17.0软件进行Meta分析。结果共纳入27篇文献,包括243530例患儿。Meta分析结果显示,中国儿童青少年遗尿症患病率为6.1%(95%CI=5.1%~7.2%),其中,男性(OR=1.52,95%CI=1.41~1.64)、遗尿症家族史(OR=3.46,95%CI=2.01~5.93)、便秘(OR=2.32,95%CI=1.59~3.40)、尿路感染史(OR=2.33,95%CI=1.81~3.01)、睡眠障碍(OR=2.01,95%CI=1.10~3.67)、尿频(OR=1.90,95%CI=1.43~2.52)、尿急(OR=1.67,95%CI=1.31~2.12)、尿失禁(OR=4.85,95%CI=2.78~8.45)是儿童青少年遗尿症的危险因素(P<0.05);排尿训练(OR=0.11,95%CI=0.02~0.46)是儿童青少年遗尿症的保护因素(P<0.05)。结论中国儿童青少年遗尿症患病率较高,性别、遗尿症家族史、便秘、尿路感染史、排尿训练、睡眠障碍、尿频、尿急、尿失禁是儿童青少年遗尿症的主要影响因素。因此,未来应对儿童青少年遗尿症进行早期识别和干预,提高家长对遗尿症的重视,做好疾病宣教普及,减少遗尿症患病率,提高患儿及家庭生活质量。

Evaluation of a new frequency-volume chart for children with primary monosymptomatic nocturnal enuresis:a prospective,comparative study

Introduction To improve compliance with voiding diaries in children with primary monosymptomatic nocturnal enuresis(PMNE),a new modified 3-day weekend frequency-volume chart(FVC)was designed,and the compliance and validity of this modified FVC was evaluated by comparing with the International Children's Continence Society(ICCS)recommended voiding diary.Methods A total of 1200 patients with PMNE were enrolled in the study from 13 centers in China and were randomly assigned to record this modified FVC or the ICCS-recommended voiding diary.The primary outcome measure was the compliance,assessed by comparing the completing index and the quality score of diaries between two groups.The secondary outcome measure was the validity,evaluated by comparing the constituent of subtypes,micturition parameters and response rate to desmopressin.Results Among the 1200 participants enrolled in the study,447 patients completed the ICCS-recommended voiding diary and 469 completed the modified diary.The diurnal completing index and the quality score of the modified FVC group were better than those of the ICCS group.In addition,there was no significant difference between these two groups in the subtype classification,or in the response rate to desmopressin.Conclusions The modified FVC could be applied to obtain the voiding characteristics of children with PMNE as the ICCS-recommended voiding diary does and offers a reasonable and better choice for children with PMNE from the unselected population in the future.

Case report: Desmopressin and somnambulism

Background: Nocturnal enuresis is caused by a mismatch between nocturnal urine production and bladder capacity. Together with a presumed decreased arousability, this results in an inability to awaken in response to a full bladder. According to recent findings, a disrupted sleep might play a role in the pathophysiology of enuresis. Case: A 7-year-old boy was diagnosed with primary nocturnal enuresis caused by nocturnal polyuria and a concomitant parasomnia, somnambulism. A polysomnographic study was performed before treating the nocturnal enuresis with the oral lyophylisate formulation of desmopressin (melt). After 1 day of treatment, both nocturnal enuresis and somnambulism disappeared. Treatment was ceased after six months. One week later, the child started to produce more urine and redeveloped nocturnal polyuria. Somnambulism reappeared followed by nocturnal enuresis two weeks later. The same treatment protocol was started up, resulting in disappearance of both nocturnal enuresis and somnambulism. Conclusion: This case report documents the beneficial effect of desmopressin melt on both nocturnal enuresis, caused by nocturnal polyuria, and a concomitant parasomnia in particularly somnambulism.

Better outcomes with desmopressin melt than enuretic alarm therapy in children with nocturnal enuresis during coronavirus disease 2019(COVID-19)

Objectives:This study aimed to investigate the effect of the coronavirus disease 2019(COVID-19)pandemic on the treatment of children with primary monosymptomatic nocturnal enuresis(MNE)with desmopressin melt versus an enuresis alarm.Materials and methods:This study included 56 children with primary MNE who were taking desmopressin melt or using an alarm.Their anxiety levels were evaluated using the Social Anxiety Scale for Children-Revised.For both treatment methods,data from a 3-month bedwetting diary between the third and sixth months of the pre-pandemic treatment were compared with those assessed during the same period during the pandemic.Results:Prior to the COVID-19 pandemic,the median 3-month mean frequency of MNE was 1(0-7.67)in children using desmopressin melt versus 1.33(0-6)in those using alarm treatment(p=0.095).During the COVID-19 pandemic period,the median monthly mean frequency of MNE was 1.33(0-7.33)in children using desmopressin melt versus 6(1.33-13)in those using alarm treatment(p<0.001).Conclusions:The COVID-19 pandemic and its accompanying psychological effects did not affect the treatment efficacy of desmopressin melt in children with primary MNE but did adversely affect that of enuresis alarms.

倍芪脐贴联合行为干预治疗儿童夜间遗尿症疗效观察

目的探讨倍芪脐贴联合行为干预治疗儿童夜间遗尿症的疗效及对儿童脑-膀胱功能轴的影响。方法选取2023年2—8月于上海儿童医学中心发育行为儿科就诊且主诉为夜间遗尿的患儿60例,随机分为治疗组和对照组各30例。治疗组给予倍芪脐贴联合行为干预治疗,对照组给予单纯行为干预治疗,2组均治疗8周。比较2组治疗前、治疗4周、治疗8周后的每周遗尿次数及治疗8周后的遗尿好转率,观察2组治疗前后脑-膀胱功能轴指标(尿意觉醒程度评分、最大日/夜间膀胱容量、最小日/夜间膀胱容量、平均日/夜间膀胱容量、次日清晨第一次尿量、单位体表面积的饮水总量、日间排尿量、夜间排尿量)及最大排尿量(MVV)/年龄预期膀胱容量(EBC)、夜间总尿量(TVV)/EBC的变化。结果2组治疗4周后每周遗尿次数均明显低于治疗前,治疗8周后明显低于治疗4周后,且治疗组治疗4周、8周后的每周遗尿次数均明显低于同期对照组,差异均有统计学意义(P均<0.05)。治疗组总有效率为63.4%(19/30),对照组总有效率为30.0%,治疗组总有效率明显高于对照组(2=6.698,P<0.05,Cohen’s d=0.70)。治疗8周后,治疗组尿意觉醒程度评分明显低于对照组(t=2.808,P<0.05,Cohen’d=0.73);2组最大和最小日间膀胱容量、日间平均膀胱容量、最大和最小夜间膀胱容量、夜间平均膀胱容量和次日清晨第一次尿量组内及组间比较差异均无统计学意义(P均>0.05);治疗组单位体表面积日间排尿量较治疗前明显增加(t=2.672,P<0.05,Cohen’s d=0.51),单位体表面积夜间排尿量较治疗前明显减少(t=2.543,P<0.05,Cohen’s d=0.67);对照组单位体表面积夜间排尿量较治疗前明显减少(t=2.238,P<0.05,Cohen’s d=0.36),日间排尿量与治疗前比较无明显变化(P>0.05)。治疗8周后,2组的MVV/EBC均较治疗前升高,但组内及组间比较差异均无统计学意义(P均>0.05);2组TVV/EBC均较治疗前明显降低(P均<0.05)。结论积极的行为干预可改善夜间遗尿症患儿脑-膀胱功能轴指标,联合倍芪脐贴治疗后可进一步改善患儿遗尿症状,主要是提高尿意-觉醒功能。

周耀庭教授治疗儿童原发性单症状性夜间遗尿症经验

文章介绍周耀庭教授治疗儿童原发性单症状性夜间遗尿症(PMNE)的经验。周教授认为,PMNE总属肾与膀胱虚寒,下元不固,与肺、脾、肾密切相关,不存在下焦湿热、肝胆湿热的病因病机;治疗应采用温肾、益气、固摄、调神、开肺之法,可取得较好临床效果。

河南省农村儿童与城市儿童夜遗尿患病率及影响因素的调查研究

目的了解农村儿童与城市儿童的夜遗尿(nocturnal enuresis,NE)患病率及尿不湿使用率和排尿训练对遗尿的影响。 方法2017年6月至2017年12月,作者随机选取河南省5个地级市的市区及其所辖农村小学及幼儿园5~12岁儿童进行NE患病率、尿不湿使用情况和排尿训练情况调查,共发放问卷3 141份,其中回收有效问卷2 773份,有效回收率为88.28%,问卷来自农村儿童 1 201 例,城市儿童1 572例。 结果 农村及城市5~12岁儿童NE患病率分别为4.33%和9.29%,差异有统计学意义(χ^2 =25.240, P <0.001);尿不湿使用率分别为76.44%和89.31%,差异有统计学意义(χ^2 = 81.949 , P <0.001);进行排尿训练的比例分别为95.75%和80.22%,差异有统计学意义(χ^2 =143.440, P <0.001 )。单因素分析发现,年龄、来源地、是否使用尿不湿、是否进行排尿训练是影响儿童发生NE危险因素( P <0.05)。多因素分析显示,来源地( OR =26.949,95%CI:13.402~ 54.188 )、不进行排尿训( OR =66.302,95%CI:34.020~129.217)是儿童NE的独立危险因素;年龄、性别和是否使用尿不湿尚没有发现与儿童NE存在关系。 结论 农村儿童NE患病率比城市儿童低,进行排尿训练的儿童NE患病率低,加强排尿训练有助于减少儿童NE的发生。

郑州市6165名5~11岁儿童夜间遗尿症的现状调查

目的调查郑州市儿童夜间遗尿症(nocturnal enuresis,NE)的发病率,并和10年前儿童夜间遗尿症的调查结果进行比较。方法自2017年5月至2017年11月,随机选择郑州市6个辖区共计20所幼儿园和小学的6 500名5～11岁儿童作为调查对象,采用匿名调查问卷的方式对原发性夜间遗尿症的流行病学情况进行调查。结果共发放问卷6 500份,回收有效问卷6 155份纳入统计分析,结果显示5～11岁儿童整体NE发病率为9.54%,男童发病率为10.09%,女童发病率为8.91%。5岁儿童NE发病率为14.48%,8岁儿童NE发病率为8.14%,11岁儿童NE发病率为3.08%,整体NE发病率随年龄增长而呈下降趋势。其中儿童患有夜间觉醒障碍以及儿童的家族直系亲属曾患有NE是儿童发病的危险因素。NE发病率高于2006年调查结果(P<0.05)。结论郑州市5～11岁儿童NE发病率较10年前升高,应引起重视并积极寻找夜间遗尿症发病率增加的原因。

252例儿童夜遗尿症的临床特征分析

目的调查夜遗尿患者临床特征,帮助医务人员准确判断夜遗尿,避免误诊和漏诊。方法回顾性分析四川大学华西医院2018年6月至2019年2月就诊的252例夜遗尿症患者的临床资料及排尿日记,分析夜遗尿症患者的临床特征。结果252例夜遗尿患者中,单症状夜遗尿患者130例(51.59%),非单症状夜遗尿患者94例(37.30%),膀胱过度活动症28例(11.11%)。出现功能性膀胱容量减少121例(48.02%),夜间多尿51例(20.23%),夜尿多及功能性膀胱容量减少16例(6.35%),夜间尿量和膀胱容量正常64例(25.40%)。夜遗尿儿童临床表现特征排前三位的是难以唤醒、便秘和饮水。儿童夜遗尿遗传因素占14.29%。结论夜遗尿就诊患者中以合并膀胱问题为主,患者最常见的临床特征为夜间睡眠过深、难以唤醒。关注夜遗尿患者的临床特征及排尿日记,正确识别、判断、决策,有助于为夜遗尿患者提供更优质的诊疗服务。

尿渗透压检测在小儿遗尿症中的应用

目的探讨尿渗透压检测在儿童遗尿症诊治中的应用价值。方法50例原发性遗尿儿童,于治疗前测定夜间尿量及尿渗透压、夜间血清抗利尿激素(AVP),并给予口服去氨加压素(DDAVP)治疗,根据DDAVP的治疗反应分为有效(DR)35例,无效(DNR)15例。30例正常儿童对照组,测定夜间尿量和尿渗透压。结果遗尿儿童夜间尿渗透压与夜间尿量呈负相关(r=-0.506,P<0.05),与夜间AVP呈正相关(r=0.725,P<0.05)。DR儿童夜间尿渗透压水平为(682.71±213.95)mOsm/L,尿量为(265.14±164.48)ml,血清AVP浓度为(4.06±1.66)pg/ml;DNR患儿夜间尿渗透压水平为(1085.00±88.88)mOsm/L,尿量为(125.33±50.97)ml,血清AVP浓度为(7.27±1.48)pg/ml。两者比较差异均有统计学意义(P<0.001)。结论遗尿儿童夜间尿渗透压与尿量、血清AVP浓度有相关性。夜间尿渗透压可反映遗尿儿童夜间AVP的分泌水平。夜间尿渗透压降低的遗尿儿童夜间AVP分泌不足,对DDAVP治疗疗效好,尿渗透压的测定对选择DDAVP治疗有参考价值。

醋酸去氨加压素治疗儿童原发性单症状性夜间遗尿症临床研究

目的探讨醋酸去氨加压素治疗儿童原发性单症状性夜间遗尿症（MNE）的疗效、减停药指征及不良反应。方法选取2013年11月至2015年5月门诊就诊的MNE患儿151例,年龄5~14岁。按照方便抽样方法将其分为加压素治疗组（n=91）和对照组（n=60）,均进行行为心理治疗,加压素治疗组加用加压素治疗。加压素治疗组中能够达到减停药标准者,又分为药物减停组（n=32）和非减停组（n=28）。药物减停组在3个月内逐渐减停,非减停组直接停药;停药后观察1个月,记录复发情况。结果 91例加压素治疗组患儿中,61例（66.7%）治疗有效;21例（22.8%）部分有效;60例对照组中,5例（7.9%）治疗有效,17例（28.3%）部分有效;两组差异有统计学意义（χ2=75.64,P=0.00）。82例加压素治疗有效或部分有效者,最终进入药物减停组32例,非减停组28例。停药后观察1个月,两组复发分别为17例（54.8%）和24例（87.5%）,复发率差异有统计学意义（χ~2=7.329,P=0.007）。结论醋酸去氨加压素治疗MNE安全、有效,逐渐减停药物可减少复发。

遗尿报警器治疗特定亚型儿童单一症状遗尿症疗效观察

目的观察遗尿报警器治疗小于年龄相应膀胱容量而无夜尿增多的单一症状遗尿症（MNE）的疗效。方法15例诊断为小于年龄相应膀胱容量而无夜尿增多的MNE患儿应用遗尿报警器治疗,并辅以睡前2 h限制饮水等基础治疗,每月复诊随访。以初次持续治疗2-3个月,连续14个夜晚无遗尿为治疗成功;停止治疗后又出现2周内遗尿≥2次为复发,并再次应用遗尿报警器治疗和随访。结果患儿男9例、女6例,平均年龄（9.76±4.24）岁（6-15岁）。第1个疗程结束时,13例治疗成功,2例因家庭配合度不佳,改用去氨加压素治疗。随访期内,5例复发,再次应用遗尿报警器治疗,4例治疗成功并未再复发,另1例治疗失败。总治愈率80%。结论遗尿报警器治疗小于年龄相应膀胱容量而无夜尿增多MNE有效。

儿童遗尿的评估和治疗进展

遗尿（NE）俗称尿床,在5岁儿童人群中发病率高达8％～20％.虽然遗尿治疗方法很多,但仍有部分患儿治疗效果不佳或停药后复发.近年来,强调根据患儿的病史、体格检查、排尿日记、尿常规等资料,必要时行尿动力学检查,找出可能的病因和发病机制,并考虑患儿年龄、遗尿类型及治疗意愿等因素制定个体化的治疗方案.

唤醒疗法与去氨加压素治疗儿童原发性遗尿症的非随机对照试验

目的 比较人工唤醒、闹钟、报警器3种唤醒治疗方式与去氨加压素治疗原发性遗尿症（PNE）患儿的疗效和依从性.方法 纳入首都医科大学附属北京儿童医院2012年4月至2013年8月就诊的6 ～ 14岁PNE患儿,根据就诊先后顺序分为人工唤醒、闹钟、报警器和去氨加压素组.4组均在基础治疗上给予相应干预,记录遗尿日记.于治疗1、3、6个月随访时,评估疗效、依从性和安全性,并行意向性分析.疗效以遗尿症状好转为评价指标.采用logistic回归分析依从性、遗尿家族史、膀胱容量等因素与疗效的相关性.结果 120例患儿符合纳入和排除标准进入研究,每组各30例.①去氨加压素、报警器、闹钟和人工唤醒组的治疗6个月的总有效率为76.7％、93.3％、56.7％和76.7％,报警器组显著高于闹钟组（P ＜0.0125）;去氨加压素组和报警器组、人工唤醒组总有效率差异无统计学意义（P≥0.0125）.②报警器组27/30例（90.0％）依从性较好,其次为去氨加压素（24/30,80.0％）、人工唤醒（18/30,60.0％）和闹钟组（16/30,53.3％）;报警器组优于人工唤醒组（P=0.007）和闹钟组（P=0.002）,报警器组和去氨加压素组差异无统计学意义.③Logistic回归分析结果显示,存在PNE家族史是影响治愈的危险因素（P =0.007,OR=0.204,95％CI：0.064～0.652）.④报警器组1例出现湿疹,去氨加压素组观察到鼻出血1例,低钠血症2例.结论 报警器、去氨加压素治疗PNE的疗效相近,且依从性和安全性均较好,可作为PNE患儿的首选治疗.

应用小剂量索利那新治疗小儿遗尿症的体会

目的探讨小剂量索利那新治疗小儿原发性夜间遗尿症的临床价值。方法 78例原发性夜间遗尿症患儿随机分为治疗组和对照组(各39例)。2组患儿均接受行为干预治疗,治疗组同时给予索利那新(5 mg/片,1/3片,每天1次)。2组均治疗3个月并随访3个月,记录2组患儿的疗效及复发率。结果疗程结束时和随访3个月治疗组有效率均高于对照组(89.7%vs 69.2%,82.1%vs 46.2%,均P<0.05)。随访观察3个月,治疗组复发率低于对照组(8.6%vs 33.3%,P<0.05)。结论小剂量索利那新治疗小儿遗尿症安全、有效,配合行为干预治疗可提高疗效,减少复发。

遗尿症患儿智力水平和智力结构分析

目的有文献报道原发性夜间遗尿症(PNE)患儿存在注意力/记忆力缺陷,并认为这种缺陷可能与患儿的智力情况有关,因此该研究对PNE患儿的智力水平和智力结构进行分析。方法采用中国韦氏儿童智力量表(C-WISC)对40例PNE患儿的智力结构进行测试,并与40例年龄和性别相匹配的正常儿童进行对照研究。结果PNE组的总智商(FIQ)、言语智商(VIQ)和操作智商(PIQ)均在正常范围,与对照组比较差异无显著性(P>0.05),但数字广度、编码、知识与算术分测验量表分与对照组比较差异有显著性(P<0.05);记忆/不分心因子(M/C)与对照组比较差异有显著性(P<0.05);两组PIQ与VIQ差值比较,差异无显著性(P>0.05)。结论PNE患儿智力水平正常,但智力结构中的记忆/不分心因子存在一定缺陷,提示可能与大脑额叶执行功能异常有关。