醋酸去氨加压素中长程疗法治疗儿童原发性单症状夜遗尿症疗效研究

摘要

目的 探讨醋酸去氨加压素中长程疗法治疗儿童遗尿症的疗效.方法 选取2013年11月至2016年3月在首都儿科研究所附属儿童医院门诊使用醋酸去氨加压素治疗的320例原发性单症状夜遗尿痘患儿,年龄5～15岁.观察治疗效果,其中治疗3～6个月能够达到减停药标准者(连续2个月干床)进一步分组,按照方便抽样的方法,分为直接停药组(DW组)和逐渐减停药组(GW组).GW组在继续治疗的9个月内逐渐减停药,DW组则直接停药;停药后观察1个月,记录复发例数.将复发与遗尿严重程度进行对比.结果 320例加压素治疗组患儿中,224例(70.1％)治疗完全有效;73例(23.0％)部分有效,治疗无效23例(6.9％).其中治疗3～6个月能够达到减停药标准者133例,去除失访,随访资料完整者107例,DW组44例,GW组63例.GW组按照减停药的方案在9个月内停药者36例.停药后观察1个月,DW组和GW组复发分别为37例(84.0％)和8例(22.2％),差异有统计学意义(P＜0.05).醋酸去氨加压素中长程治疗(12～15个月)者,均未出现明显不良反应.两组中复发者和逐渐减停药组中治疗时间＞12个月者,中重度遗尿症的比例较未复发组明显增高,差异有统计学意义(P＜0.05).结论 醋酸去氨加压素治疗原发性单症状夜遗尿症患儿安全、有效,中长程疗法可明显降低复发率.中重度遗尿较轻度遗尿更易复发.%Objective To explore the effect of intermediate-long term therapy with desmopressin acetate (DA) in treating children with enuresis.Methods Totally 320 PMNE children treated with DA aged 5-15 years from November 2013 to March 2016 were included.The cases who stopped wetting bed for 2 months within 3-6 months of treatment were observed.According to convenience sampling method,the observed patients were divided into gradually withdraw (GW) group and immediate withdraw(DW) group.GW group use taper therapy and DA was gradually withdrawn within 9 months.In DW group DA was withdrawn immediately.The relapse cases were recorded 1 month after discontinuation of DA in the two groups.Compare the relapse and severity of enuresis.Results Response of DA:full response (FR) in 224 cases (70.1％),partial response (PR) in 73 cases (23.0％) and no response (NR) in 23 cases (6.9％).Totally 133 cases(continuously 2 months of dry bed) were up to withdrawal criteria in 3-6 months.Totally 26 cases were lost follow-up and 107 cases were observed,63 cases were included in GW group and 36 cases had DA withdrawal within 9 months;44 cases were included in DW group.The relapse cases were 37 cases (84.1％) in DW group,and GW group,8 cases (22.2％).The relapse rate was significantly different between the two groups.No obvious adveme events were observed in 27 cases with DA treatment for 1 year.Moderate-severe enuresis cases of the recurrence ones and the cases treated for 1 year were significantly higher than those of the non-recurrent cases.Conclusion DA is a safe and effective way to treat PMNE.Gradually withdrawing the DA in intermediate-long term treatment can obviously decrease the recurrence of PMNE.The recurrence rate is higher in moderate-severe enuresis than that of mild cases.