小儿原发性夜间遗尿症尿动力学评价的初步探讨

目的 探讨小儿原发性夜间遗尿症的病因和膀胱功能改变。方法 本组63例，男39例，女24例。在清醒和自然睡眠相进行充盈期膀胱压力容积测定，记录睡眠相盆底肌电活动变化。结果 58例存在膀胱功能紊乱，多种异常合并为五种模式。其中，睡眠相逼尿肌不稳定收缩占71.4%(45/63)，睡眠相膀胱最大测量容量下降占36.5%(23/63)。睡眠相逼尿肌不稳定收缩出现时，逼尿肌与盆底肌肉协同失调者11例。结论 逼尿肌不稳定收缩是遗尿发生的主要原因，盆底肌肉与逼尿肌的协同失调可能是原因之一，膀胱容量下降是逼尿肌不稳定收缩所致的遗尿结果而不是原因。     

遗尿症与非遗尿症儿童的晨尿渗透浓度测定

目的探讨原发性夜遗尿症(PNE)儿童晨尿渗透浓度与非遗尿儿童有否差异,是否可以反映夜间抗利尿激素分泌水平。方法研究对象为2006-01—2006-08在华中科技大学同济医学院同济医院肾脏专科门诊就诊的患儿。用FM-8P冰点渗透浓度计前瞻性测定18例PNE患儿(病例组)和20例年龄、性别相匹配的非遗尿儿童(对照组)清晨(6:00～7:00)起床第1次尿和白天(14:00～15:00)随机尿的渗透浓度,采用酶联免疫吸附试验法测定凌晨1:00和下午15:00的血清抗利尿激素(ADH)水平。结果病例组晨尿渗透浓度[(682.06±222.68)mmol/L]比白天尿渗透浓度[(712.06±336.25)mmol/L]没有升高(P=1.000)且明显低于对照组晨尿渗透浓度[(911.40±235.98)mmol/L,P=0.023]及晨尿渗透浓度正常值低限(800mmol/L)(t=2.247,P=0.038);白天尿渗透浓度病例组和对照组分别为(712.06±336.25)mmol/L和(759.91±281.53)mmol/L,差异无显著性(P=1.000);血清ADH夜间(1:00)病例组为(1.58±0.35)pg/mL比白天[(15:00,2.48±1.72)pg/mL]无升高(P=0.834)且明显低于对照组夜间血ADH水平[(4.18±0.86)pg/mL,P=0.000],而对照组夜间ADH明显高于白天(15:00)[(2.10±1.35)pg/mL,P=0.002]。结论PNE患儿晨尿渗透浓度比白天没有升高且明显低于非遗尿儿童,与抗利尿激素夜间分泌减少相一致。提示晨尿渗透浓度可以间接反映PNE患儿夜间的抗利尿激素分泌情况。     

血,尿渗透压,纯水清除率,血肌酐在小儿肾脏疾病中的意义

我们对56例原发性肾小球疾病患儿进行了血渗透压(Sosm)、尿渗透压(Uosm)、纯水清除率(CH_2O)和血肌酐(SCr)测定,比较各项检查结果,以求早期发现肾功能损害程度及判断预后,现将结果报道如下。     

尿变形红细胞的临床意义及终末尿渗透压对尿红细胞形态的影响

本文应用涂片染色法观察了42例血尿患者尿红细胞形态及终末尿渗透压对红细胞形态的影响。发现终末尿渗透压对红细胞形态有一定影响,但不会造成红细胞的严重变形。提示尿严重变形红细胞是诊断肾小球性血尿的指示性细胞。认为涂片染色法观察尿中红细胞形态可区别肾小球性血尿和非肾小球性血尿。     

窒息新生儿血和尿钠及渗透压变化

窒息新生儿血和尿钠及渗透压变化（遵义医学院附属医院儿科５６３００３）曹云涛，张贵萍，刘温泉，陈娟新生儿窒息因缺血缺氧可引起包括脑功能在内的多器官功能损害，窒息后抗利尿激素异常分泌综合征（ＳＩＡＤＨ）的发生亦是引起脑损伤的原因之一，我们对５３例不同程度...     

原发性遗尿症儿童感觉统合能力的对照研究

目的：探索儿童原发性夜间遗尿症（PNE）与感觉统合能力的关系。方法：采用儿童感觉统合能力发展量表,对70例PNE患儿进行感觉统合功能测试,并与74例正常儿童进行对照研究。结果：PNE组感觉统合失调发生率 (76% vs 35%)、重度感觉统合失调发生率(39% vs 18%) 明显高于对照组,差异有统计学意义（P<0.01）。PNE组儿童所有感觉统合功能因子得分均明显低于对照组,差异有统计学意义（P<0.01）。结论：PNE患儿普遍存在感觉统合失调,并且是多方面的,故对PNE患儿进行感觉统合功能测试,并针对性地对伴发的感觉统合失调问题进行训练很有必要。［中国当代儿科杂志,2010,12（5）：341-343］     

305例原发性遗尿症儿童尿流率检测结果分析

目的通过分析尿流率检测结果评价原发性遗尿症患儿的膀胱尿道功能。方法选择2001年10月￣2005年8月在我院尿动力学室进行尿流率检测的原发性遗尿症患儿。患儿先饮水,待有强烈尿意时,在不受干扰的环境中采取自然体位排尿于尿流率测量仪器上。记录最大尿流率、平均尿流率、排尿时间、尿流时间、尿量、达峰时间及尿流曲线等,同时于肛门口贴电极片同步测量盆底肌募集肌电图。结果原发性遗尿症患儿共305例,男183例,女122例。平均年龄8.4±0.3岁(5～18岁)。白天有尿频、尿急、湿裤症状的复杂性遗尿病例225例,占73.8%;单症状性夜间遗尿病例80例,占26.2%。88.2%的患儿有效膀胱容量减小,其中单症状性夜间遗尿患儿中,82.1%存在有效膀胱容量减小,而复杂性遗尿患儿中90.0%有此现象,二者相比,差异有统计学意义(P<0.05)。7～14岁女孩最大尿流率平均为19.7±1.2ml/s,明显小于正常(P<0.05),男孩为18.6±1.1ml/s。尿流率曲线中钟形曲线占54.8%;Staccato排尿曲线占12.5%;间断排尿曲线占7.2%;功能性膀胱出口梗阻形曲线占14.4%。128例(占42.0%)患儿排尿时出现收缩的肌电图信号。结论通过尿流率分析发现部分原发性遗尿症患儿存在膀胱尿道功能异常,表现为有效膀胱容量减小、最大尿流率降低和逼尿肌-括约肌收缩不协调等。与尿动力学检查相比,尿流率检测无创易行,值得在原发性遗尿症儿童中进行。     

小儿先天性肾积水解除梗阻后尿量和尿成分的测定及其临床…

测定积水肾肾小球及肾小管功能，了解尿液测定的临床意义。对２１例单侧先天性肾积水进行研究，术后６～８天分别收集健康患两肾尿液，测定Ｍｇ＾＋＋，Ｎａ＾＋，Ｃｌ＾－，Ｃａ＾＋＋，Ｋ＾＋，β２Ｍ及相以肾小球滤过率（ＲＧＦＲ）。结果，患肾对Ｍｇ＾＋＋，Ｎａ＾＋，Ｃｌ＾－的排泄分数增高，Ｍｇ＾＋＋的排泄量增高，Ｃａ＾＋＋〉Ｋ＾＋，β２Ｍ改变不明显，对其中１８例测定ＲＧＦＲ，３例ＧＦＲ〈２５％，说明患肾肾小球滤     

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。［中国当代儿科杂志,2007,9（5）：433-435］     

少尿和无尿

1 定义 少尿:24h尿量<250mL,不同年龄患儿少尿的诊断标准见表1.无尿:24h内尿量<50mL或新生儿尿量<0.5mL·kg-1·h-1为无尿.     

遗尿症儿童感觉统合能力的研究

目的：分析原发性夜间遗尿症(PNE)儿童的感觉统合能力,探讨感觉统合失调在原发性遗尿症发生中的作用。方法：采用感觉统合能力发展量表对46例PNE组儿童及46例正常对照组儿童进行感觉统合功能测试,对两组结果采用t检验和χ2检验进行统计分析。结果：PNE组与对照组儿童感觉统合失调的发生率分别为82.6%和43.5%,其中重度失调的发生率分别为36.9%和2.1%,两组间差异有显著性（P﹤0.01）;PNE组所有感觉统合功能因子得分均明显低于对照组,差异有显著性(P﹤0.01)。结论：PNE组儿童存在感觉统合失调现象,感觉统合功能失调在PNE发生中可能有一定作用。     

原发性遗尿症患儿治疗前后自我意识变化的初探

目的 分析评估儿童原发性遗尿症（PNE）自我意识评价状况以及遗尿治疗对自我意识的影响。方法 选择2005年7月至2006年1月在复旦大学附属儿科医院确诊的8~16岁PNE患儿为研究对象。排除患有可引起尿床的器质性疾病、治疗前存在高血压、单亲家庭、父母离异、有其他家庭问题及慢性疾病的患儿。指导PNE患儿自己填写Piers Harris儿童自我意识量表(PHCSS)。随后患儿分3组接受不同方法治疗遗尿:生物反馈治疗组、口服醋酸去氨加压素治疗组和口服中药治疗组，疗程均为1个月。治疗结束3个月后再次指导患儿自己填写PHCSS。通过心理分析软件分析两次自我意识评价结果。结果 研究期间共纳入PNE患儿54例，男29例，女25例，平均年龄（10.0±0.6）岁。其中轻度遗尿15例，中度遗尿20例，重度遗尿19例。治疗遗尿前54例患儿自我意识评价结果中焦虑得分显著低于常模（P<0.01）；并且轻、中和重度PNE患儿焦虑得分均显著低于常模（P<0.01），不同遗尿严重程度患儿得分差异无统计学意义。其中12例接受生物反馈治疗，14例接受醋酸去氨加压素治疗，28例接受中药治疗。治疗后有44例接受了自我意识评价随访，治疗遗尿后患儿焦虑得分较治疗前明显增加（P<0.05），其中口服醋酸去氨加压素组治疗后焦虑得分明显提高（P<0.05）。遗尿治疗有效的患儿得分明显高于治疗前（P<0.05），而治疗无效的患儿治疗前、后自我意识各项得分差异无统计学意义。结论 治疗前PNE患儿自我意识评价结果中焦虑得分低下，通过治疗遗尿其自我意识评价也可得到改善，并且临床疗效好的患儿自我意识改善明显。     

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。     

Going Dutch in nocturnal enuresis

Based on several intervention programmes, a strategy for the treatment of nocturnal enuresis has recently been developed by an expert committee in the Netherlands. It consists of three parts. First, two structured interviews are given: one to differentiate between enuresis and incontinence and one to detect associated problems such as diurnal enuresis, constipation or behavioural problems. Secondly, a medical examination is made, confined to the inspection of the external genitalia and lower back, palpation of the abdomen and urine examination. Thirdly, the following guidelines for treatment at different age levels are applied: up to the age of 6 years no intervention is needed; between the ages of 6 and 8 years, lifting out of bed and/or the calendar method; between the ages of 8 and 12 years, enuresis alarm (if not successful, medication with desmopressin is prescribed for a restricted period of time), and ambulatory dry-bed training in a group setting may follow; over 13 years of age, clinical dry-bed training according to the Messer/Azrin method is advised. According to the expert committee, these guidelines offer sufficient possibilities to deal with the problem of nocturnal enuresis.     

DNA damage in children treated with imipramine for primary nocturnal enuresis

BACKGROUND: Despite the fact that primary nocturnal enuresis (PNE) is self-limited and pathologically benign, the emotional stress and inconvenience that it produces, warrants treatment. Imipramine is one of the widely used drugs in PNE treatment. Although some mutagenic effects were suggested in imipramine administration, this toxicity has never been investigated in enuretic patients. The aim of this study was to evaluate the association of exposure to imipramine with DNA damage. METHODS: Thirty-five children treated with imipramine for at least 4.5 months who were in otherwise good health were accepted into the investigation. Twenty healthy sisters or brothers of the patients who did not use any long-term drugs were studied simultaneously as the control group. Comet assay was used to evaluate DNA damage. RESULTS: Damaged (limited and extensive migrated) cells of the enuretic children who were taking imipramine were statically higher than that of the control group (P < 0.05) indicating a detectable DNA damaging effect of imipramine in human lymphocytes. CONCLUSIONS: Our finding suggests that the difference in comet scores between two groups was induced by the imipramine treatment. The other possibility to be considered is the psychological stress of the children who were concerned by the symptoms and their parent's anxiety. As our preliminary data were based on a limited number of children, further research is needed considering the importance of this possible toxic effects which may be associated with mutagenicity.     

Family and segregation studies: 411 Chinese children with primary nocturnal enuresis

BACKGROUND: The aim of the present paper was to determine the incidence of primary nocturnal enuresis (PNE) among relatives of Chinese children with PNE, the inheritance pattern, and to identify the characteristics of PNE with positive family history. METHODS: From July 2003 to June 2004, an epidemiological survey on PNE children was carried out by self-administered questionnaires to parents of 5-18-year-old Chinese students in Henan Province, central China. A detailed family history was recorded in order to determine the presence of familial PNE as defined as any close relative with PNE beyond the age of 5 years. RESULTS: The response rate was 88% (10 383/11 799), and 411 children (235 boys and 176 girls) with PNE were identified. A positive family history was found in 94 families (22.87%) of 411 probands with PNE, including 48.94% of fathers, 8.51% of mothers, 6.38% of both parents, 6.38% of the siblings and 29.79% of grandfathers or (and) mothers. Among the probands the ratio of male to female was 1.3:1 excluding sex-linked inheritance. Autosomal dominant inheritance was in 14.60%, and autosomal recessive inheritance was consistent in 1.46% of families. In PNE children with positive family history, the proportion of adolescents, with associated daytime symptoms, marked PNE and seeking professional help were significantly higher than those in PNE children without positive family history. CONCLUSIONS: PNE has a significant family clustering, and all modes of inheritance can occur in different families on the basis of a formal genetic analysis. Those with positive family history often manifest marked PNE, and have daytime symptoms.