吲达帕胺治疗中枢性尿崩症的疗效及机制探讨

目的：观察吲达帕胺治疗中枢性尿崩症的疗效并初步探讨其作用机制。方法：采用随机区组设计，对８例中枢性尿崩症患者轮流给予吲达帕胺２５～７５ｍｇ·ｄ－１或卡马西平１５０～３００ｍｇ·ｄ－１或双氢氯噻嗪５０～７５ｍｇ·ｄ－１口服治疗，连续８ｄ，停药４ｄ，依次更换药物二次，动态观察尿量及水盐代谢指标。结果：三药在用药的第４ｄ，第８ｄ尿量均较用药前为低；吲达帕胺在用药的第４ｄ、第８ｄ血钾、血氯较用药前降低，肾性活性较用药前升高（Ｐ＜０．０５）。结论：吲达帕胺对中枢性尿崩症有抗尿崩作用，电解质的改变和肾素血管紧张素醛固酮系统可能参与抗尿崩机制     

吲达帕胺与氯沙坦治疗老年高血压的比较

吲达帕胺为非噻嗪类吲哚的衍生物,具有轻度利尿及钙拮抗作用。氯沙坦是血管紧张素Ⅱ(AngⅡ)受体抗拮抗剂,通过拮抗AngⅡ一受体AT1,阻断AngⅡ升高血压及靶器官损伤的作用。两药是近年国内外治疗高血压病的常用新药。本文对两药治疗老年高血压病的疗效及副作用进行了比较,现报道如下。     

吲达帕胺治疗高血压病46例疗效分析

本文观察了吲达帕胺（Ｉｎｄａｐａｍｉｄｅ）治疗Ⅰ、Ⅱ期高血压病患者４６例的降压效果及其对血脂、血电解质、血糖等影响。结果表明：降压效果非常显著（Ｐ＜０．０１）；血浆胆固醇（ＴＣ）、低密度脂蛋白胆固醇（ＬＤＬ－ｃｈ）明显降低（Ｐ＜０．０５），而高密度脂蛋白胆固醇（ＨＤＬ－Ｃｈ）则升高（Ｐ＜０．０５）；对血糖、血电解质影响甚微（Ｐ＜０．０５）。提示该药是较为理想的抗高压药物。     

吲达帕胺治疗老年性高血压疗效观察

吲达帕胺 (Indapam ide简称 IDP)具有利尿、钙拮抗作用 ,是对前列腺素系统有良好影响的新型降压药。我院 1998年 1月至 2 0 0 0年 5月在老干部科对老年性高血压试用 IDP治疗 ,现将疗效报告如下。1　对象与方法1.1　病例选择　按 WHO高血压的诊断标准 ,选取我院干部病房患者 86人 ,男 6 6例 ,女 2 0例 ,年龄 6 1～ 86岁 ,平均 74.5岁。高血压病程 1～ 32年 ,平均 18年 ;均排除继发性高血压。其中 期 15例 , 期 30例 , 期 43例。按入院先后为序随机分 A组、 B组各 43例。1.2　治疗方法　入院病人停用其他降压药。A组 :用吲达帕胺 (法国…     

卡托普利联合吲达帕胺治疗高血压病疗效观察

目的 观察卡托普利联合吲达帕胺的降压作用、不良反应及对代谢的影响。方法 按1999年WHO标准选取原发性高血压病患者120例，随机分为卡托普利加吲达帕胺组60例和卡托普利组60例，疗程4周，由固定医生测坐位血压，于治疗前后测血糖、血脂、电解质、肝功、肾功，并行心电图检查。结果 卡托普利加吲达帕胺组和卡托普利组在服药4周后总有效率分别为88．3％、66，7％，对糖代谢、脂代谢、电解质、肝功、肾功及心电图无明显影响。结论 两药联合降压效果好，副作用小，值得临床推广应用。     

吲达帕胺与硝苯吡啶治疗老年高血压疗效比较

吲达帕胺与硝苯吡啶治疗老年高血压疗效比较广西区江滨医院常景梅吲达帕胺是具有利尿和钙拮抗作用的一种强效、长效降压药，对血管平滑肌有较高的选择性，使外周血管阻力下降，产生降压效果，这与阻滞钙离子内流有关（１）。文献报道该药对轻、中度高血压疗效显著（２）。...     

吲达帕胺个体化治疗高血压病18例疗效观察

当前抗高血压药物中,吲达帕胺(Indapamide)为一种疗效显著、副作用少、服用方便的新型长效降压药。但是价格比较贵,每片2.5mg0.59元。成人常规用药2.5mg,每日一次口服。减少用量能否得到满意的疗效?为此。做如下观察。     

吲达帕胺对高血压左心室肥厚的逆转作用

目的 观察新型噻嗪类利尿剂吲达帕胺逆转左心室肥厚（ＬＶＨ）的效果,方法 ９６例高血压的ＬＶＨ患者,分别给予吲达帕胺（Ａ组,５０例）２．５～５ｍｇ／ｄ和硝苯地平控释片（Ｂ组,４６例）２０～６０ｍｇ／ｄ持续１２个月治疗,观察治疗前后血压及左室结构变化。结果 两组治疗前后血压、室间隔厚度（ＩＶＳＴ）、左心室后壁厚度（ＰＷＴ）、心室重量指数（ＩＶＭＩ）和左心 射血分数（ＬＯＶＥＦ）均有改善（Ｐ〈）．０５～     

吲达帕胺治疗轻,中度高血压30例疗效观察

观察了３０例轻，中度高血压病人吲达帕安治疗的降压疗效及其对血清电解质，血脂，心肾功能的影响，结果显示：降压效果明显（Ｐ〈０．０５），对血清Ｋ＾＋，Ｎａ＾＋，Ｃｌ＾－，Ｃａ＾２＋影响甚微（Ｐ〉０．０５），对ＴＣ，ＴＧ和血糖及心，肾功能无明显影响，提示该药为较好的抗高血压一线药物。     

Hereditary central diabetes insipidus: plasma levels of antidiuretic hormone in a family with a possible osmoreceptor defect

A large Canadian kindred of Irish extraction extending from Quebec to British Columbia with autosomal dominant diabetes insipidus responsive to exogenous antidiuretic hormone (ADH) is described. Out of 121 individuals 34 have been identified as affected in seven generations. The disorder is characterized by variability in age at onset and in severity, and by apparently spontaneous abatement in old age. The affected subjects do not appear to manifest hypertension or its sequelae. In three individuals tested the plasma ADH level was very low in spite of adequate osmotic stimulation. However, the level rose in two of them when they were given furosemide, which suggests an osmoreceptor defect and a normal ADH response to volume change.     

中枢性尿崩症的MRI研究

目的：研究中枢性尿崩症的低场MRI表现。方法：对31例中枢性尿崩症、43例下丘脑－垂体区病变及12例结核性脑膜炎行MRI检查;分析了丘脑和神经垂体的MRI改变,探讨尿崩症与病变的关系。结果：中枢性尿崩症垂体后叶高信号96．8％消失,呈低信号;继发性尿崩症在下丘脑－垂体区存在浸润性病灶,病灶浸润下丘脑有85．7％出现尿崩症,垂体及正中隆起病变,使下丘脑受压,有5．3％的人出现尿崩症,仅1例（5％）垂体腺瘤出现尿崩症;病灶的大小与尿崩症无相关性。结论：中枢性尿崩症垂体后叶96．8％呈长T1低信号;下丘脑浸润性病灶多导致继发性尿崩症。     

大鼠去垂体术后中枢性尿崩的实验研究

目的 观察立体定向手术切除垂体后大鼠尿崩症发生情况.方法 将80只雄性Wistsx大鼠随机分为2组,每组40只.实验组通过立体定向垂体切除仪经耳道吸除垂体,2组大鼠均测量术前、术后1 h、术后第1、2、3、4、7天尿量和尿密度,取血检测术后第1天和第7天血浆抗利尿激素(antidiuretic hormone,ADH)浓度.结果 立体定向去垂体成功率92.5%(37/40),去垂体大鼠(实验组)存活率97.3%(36/37).实验组术后第1天尿崩症状明显,尿量[(2.44±0.30)ml/h]比对照组[(0.46±0.14)ml/h]明显增加(P<0.01),尿密度[(1.011±0.002)g/L]比对照组[(1.034±0.003)g/L]明显降低(P<0.01),血浆ADH浓度[(230.73±13.30)ng/L]比对照组[(951.32±23.11)ng/L]明显下降(P<0.01).实验组术后第2天起尿量、尿密度逐渐恢复,第3天开始2组尿量、尿密度无明显差异(P>0.05),实验组尿崩症状消失.结论 经立体定向去垂体术后,大鼠急性期(24 h)可出现明显的尿崩症状,自术后第2天起逐渐缓解.     

Low serum urea level in dehydrated patients with central diabetes insipidus.

Dehydrated patients usually present with an elevated serum urea level, owing in part to increased renal reabsorption of urea mediated by antidiuretic hormone (ADH). We carried out a study to examine whether, during dehydration, the variations in the serum urea level could discriminate patients with central diabetes insipidus (CDI) from those with dehydration not due to CDI. We studied retrospectively 27 episodes of dehydration in 23 patients with CDI and 14 episodes in 14 patients without CDI. The mean serum urea level was 2.9 mmol/L in the CDI group and 15.4 mmol/L in the patients without CDI (p less than 0.001); the mean serum sodium level was 155 mmol/L in both groups. All the patients with CDI had a sodium/urea ratio greater than 24.2, whereas the ratio was less than 21.7 in all the patients without CDI. In the patients with CDI a positive correlation was found between the magnitude of diuresis and the percentage decrease in the serum urea level compared with the level before dehydration (p less than 0.001). In the patients with CDI the serum urea level returned to the level before dehydration after the administration of vasopressin; a striking increase in the clearance of urea, which exceeded the creatinine clearance, was observed during dehydration in the three patients in whom clearance studies were done. The results suggest that serum urea values can be used to distinguish patients dehydrated because of CDI from those with hypertonic dehydration but without ADH deficiency and that during dehydration the net reabsorption of urea is dependent on the renal action of ADH.     

神经外科术后中枢性尿崩症ADH变化曲线及其临床意义

目的：探讨神经外科术后并发中枢性尿崩症时血清抗利尿激素（ADH）变化曲线对判断不同类型中枢性尿崩症的临床意义。方法：动态观察神经外科手术后出现中枢性尿崩患者158例，采用放射免疫法测定患者术前及术后2周内不同时间点血清ADH浓度，绘制短 暂性、持续性及三相性尿崩症AHD变化曲线。结果：短暂性和三相性尿崩症术后血清ADH立即下降，于术后第2天达最低值，分别为术前血清ADH浓度的41.7%和63.6%，与术前比较差异有显著性（P<0.05）。短暂性尿崩症于术后第10天恢复术前水平，而三相性尿崩症在术后第7天血清浓度达高峰，超过术前水平，后逐渐下降。持续性尿崩症患者术后 血清ADH于术后1 d后下降，于术后第7天 最低值，为术前血清ADH水平的33.3%，后略有波动，但在2周内一直低于术前ADH水平（P<0.05）。结论： 通过对血清ADH变化曲线的分析，可以区分不同类型的中枢性尿崩症，进行有针对性的治疗，改善患者预后。     

Masking of central diabetes insipidus and hypogonadotrophic hypogonadism by germ cell tumour in suprasellar--pineal region

A patient with beta hCG-secreting germ cell carcinoma of the pineal and suprasellar regions presented with hydrocephalus, Parinaud's syndrome, hypopituitarism and polyuria. Central diabetes insipidus was strongly suspected although the water deprivation test was not diagnostic. The polyuria however, responded to ADH analogue when the hypothyroidism and hypocortisolism were treated. Pubertal development was evident and serum testosterone was normal despite the low FSH/LH, suggesting hCG stimulation of Leydig cells. This case illustrates that a beta hCG-germ cell tumour of the suprasellar region causing hypopituitarism can mask the presence of central diabetes insipidus and hypogonadotrophic hypogonadism.     

82例中枢性尿崩症MRI特点与临床分析

目的:探讨中枢性尿崩症的磁共振成像(MRI)表现,结合临床分析以期评价MRI对该病的诊断价值.方法:回顾分析经禁水-垂体加压素试验证实为阳性的中枢性尿崩症患者126例,其中82例[男46例,女36例;年龄(25±3)岁;病程20 d～15年]进行了脑部 MRI检查,结合临床资料和MRI表现,探讨该病行MRI检查的重要性.结果:82例中58例显示垂体后叶高信号消失,占70.7%;16例显示垂体后叶高信号仍存在,占19.5%;8例鞍区有肿瘤,占9.8%.结论:MRI是目前显示垂体结构最佳的影像学方法,对中枢性尿崩症的诊断有重要价值.