儿童阻塞性睡眠呼吸暂停低通气综合征对抗利尿激素水平的影响

目的 探讨儿童阻塞性睡眠呼吸暂停低通气综合征(obstructive sleep apnea hypopnea syndrome,OSAHS)对体内抗利尿激素(antidiuretic hormone,ADH)分泌水平的影响.方法 30例确诊为OSAHS的患儿分别于扁桃体+腺样体切除术前和术后行多道睡眠监测,在深睡期取静脉血采用放射免疫技术检测患儿血浆中ADH水平并记录夜间12 h尿量,与20例健康儿童夜间深睡期ADH水平和12 h夜尿量进行比较分析.结果 OSAHS患儿呼吸暂停低通气指数术后2个月由术前(17.4±2.6)次/h(-x±s,下同)下降至(3.3±1.4)次/h,最低动脉血氧饱和度由0.783±0.134上升至0.954±0.062,差异有统计学意义(t值分别为27.68和6.45,P值均＜0.001).OSAHS患儿夜间血浆ADH水平为(63.1±35.2)ng/L,明显低于健康儿童的(85.1±22.2)ng/L,夜尿量(492±90)ml显著高于健康儿童(346±62)ml,差异有统计学意义(t值分别为2.75和6.43,P值均＜0.01);治疗后ADH达(83.1±21.2)ng/L,较术前明显上升(t=2.56,P＜0.05),夜尿量(332±56)ml较术前明显下降(t=7.85,P＜0.001),与健康儿童相比差异均无统计学意义(t值分别为0.17和0.77,P值均＞0.05).结论 OSAHS患儿可能因夜间ADH水平下降导致夜尿增多,解除呼吸道梗阻使患儿睡眠恢复正常,可能促使ADH水平趋于正常,夜间尿量减少.

Influence on antidiuretic hormone secretion in children with obstructive sleep apnea hypopnea syndrome

OBJECTIVE: To explore the influence of obstructive sleep apnea hypopnea syndrome (OSAHS) in children on the secretion of antidiuretic hormone (ADH). METHODS: Thirty pediatric patients with OSAHS were examined with polysomnography (PSG) and urinary volume was recorded during sleep, and vein blood was sampled in deep sleep to detect the level of ADH in serum using radioimmunoassay technique, which were performed before and after adenotonsillectomy. Among twenty heath children were also detected the secretion of ADH as normal controls. RESULTS: After surgery, apnea-hypopnea index (AHI) decreased (from 17.4 +/- 2.6 to 3.3 +/- 1.4, t = 27.68, P < 0.001), lowest SaO2 increased (from 0.783 +/- 0.134 to 0.954 +/- 0.062, t = 6.45, P < 0.001). The level of ADH in OSAHS patients (63.1 +/- 35.2) ng/L was much lower than that in health children (85.1 +/- 22.2) ng/L (t = 2.75, P < 0.01). The serum ADH level in postoperative patients (83.1 +/- 21.2) ng/L was increased significantly compared with that of preoperative (t = 2.56, P < 0.05), and no statistical difference versus that of health children (t = 0.17, P > 0.05). Nycturia volume of preoperative OSAHS children (492 +/- 90) ml was significant higher than that of postoperative (332 +/- 56) ml or normal controls (346 +/- 62) ml (t was 7.85 and 6.43, both P < 0.001). There was no significance in nycturia volume between postoperative group and control group (t = 0.77, P > 0.05). CONCLUSIONS: After adenotonsillectomy in children with OSAHS caused by adenotonsillan hypertrophy, the sleep pattern and ADH secretion could become normal.