去氨加压素对单症状遗尿症患儿症状及睡眠质量影响

doi:10.12372/jcp.2022.21e1237

摘要/Abstract

摘要： 目的探讨去氨加压素（DDAVP）治疗单症状遗尿症（MNE）患儿症状和睡眠改善情况。方法选择2018—2020年门诊就诊的69例MNE患儿进行为期12周的DDAVP治疗随访研究,12周后根据遗尿改善情况将患儿分为治疗改善组和无改善组,分析DDAVP治疗对遗尿症状和睡眠质量的影响。结果基线入组的69例MNE患儿中,7例中途退出随访,最终纳入62例,男34例、女28例,平均年龄（8.77±1.94）岁。接受DDAVP治疗的MNE患儿,基线、第4周、第8周、第12周的遗尿夜晚数、儿童睡眠习惯问卷（CSHQ）总分、遗尿发生时间、平时及周末睡眠时间差异均有统计学意义（P<0.05）,第12周遗尿夜晚数和CSHQ总分较基线值明显下降,遗尿发生时间、平时及周末睡眠时间较基线值明显延长,差异均有统计学意义（P<0.05）。与无改善组（n=22）相比,第8周、第12周改善组（n=40）的CSHQ总分较低,遗尿发生时间、平时和周末睡眠时间均明显延长,每周遗尿夜晚数减少,差异有统计学意义（P<0.05）。从CSHQ评分8个层面得分来看,改善组在就寝习惯、入睡潜伏期、睡眠持续时间、睡眠焦虑、夜醒、异态睡眠及白天嗜睡层面的得分差异均有统计学意义（P<0.05）,无改善组仅在睡眠持续时间层面的差异有统计学意义（P<0.05）。结论 DDAVP治疗12周可明显改善MNE患儿的症状并提高其睡眠质量。

关键词: 去氨加压素, 单症状遗尿症, 睡眠, 儿童

Abstract: Objectives To investigate the improvement of symptoms and sleep in children with monosymptomatic nocturnal enuresis (MNE) treated with desmopressin (DDAVP). Methods A total of 69 children with MNE who were treated in our clinic from 2018 to 2020 were selected for a 12-week follow-up study of DDAVP treatment. After 12 weeks, the children were divided into improvement group and non-improvement group according to the remission of enuresis, and the effect of DDAVP treatment on enuresis symptoms and sleep quality was analyzed. Results Among the 69 children with MNE enrolled at baseline, 7 dropped out of the follow-up, and 62 were eventually included, including 34 boys and 28 girls, with an average age of (8.77±1.94) years. In all MNE children treated with DDAVP, there were statistically significant differences in the number of enuresis nights, total score of the children's sleep habits questionnaire (CSHQ), occurrence time of enuresis, and sleep time on weekdays and weekends between baseline, weeks 4, 8 and 12 (P<0.05). Compared with baseline, the number of enuresis nights and the total score of CSHQ at week 12 were significantly decreased, and the occurrence time of enuresis and sleep time on weekdays and weekends were significantly prolonged, and the differences were statistically significant (P<0.05). Compared with the non-improvement group (n=22), the improvement group (n=40) at week 8 and 12 had lower CSHQ scores, significantly longer enuresis occurrence time, sleep time on weekdays and weekends, and fewer enuresis nights per week, and the differences were statistically significant (P<0.05). In terms of CSHQ scores at 8 levels, there were statistically significant differences in the scores of sleeping habits, sleep latency, bedtime duration, sleep anxiety, night waking, parasomnias and daytime sleepiness in the improvement group (P<0.05), while there was statistically significant difference only in bedtime duration in the non-improvement group (P<0.05).Conclusion DDAVP treatment for 12 weeks can significantly improve the symptoms and sleep quality of children with MNE.

Key words: desmopressin, monosymptomatic nocturnal enuresis, sleep, child

吕磊, 王一鹤, 胡绘杰, 赵莹, 刘二鹏, 张艳平, 蒲青崧, 杨兴欢, 汲凤平, 文建国. 去氨加压素对单症状遗尿症患儿症状及睡眠质量影响[J]. 临床儿科杂志, 2022, 40(4): 294-299.

LYU Lei, WANG Yihe, HU Huijie, ZHAO Ying, LIU Erpeng, ZHANG Yanping, PU Qingsong, YANG Xinghuan, JI Fengping, WEN Jianguo. Effects of desmopressin on symptoms and sleep quality in children with monosymptomatic nocturnal enuresis[J]. Journal of Clinical Pediatrics, 2022, 40(4): 294-299.

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项目	基线	第4周	第8周	第12周	统计量	P
每周遗尿夜晚数[M(P₂₅~P₇₅)]	4.0(3.0~4.3)	3.0(3.0~4.0)	3.0(2.0~3.0)	2.0(1.0~3.3)¹⁾	H=46.92	<0.001
CSHQ总分(x±s)	61.1±4.5	59.3±4.7	55.8±4.2	53.7±4.8¹⁾	F=33.84	<0.001
遗尿发生时间(x±s)/min	109.8±24.8	126.3±21.1	146.0±24.8	170.9±28.5¹⁾	F=69.01	<0.001
每日睡眠时间(x±s)/min
平时	562.2±33.1	577.7±32.2	587.4±28.55	593.4±31.8¹⁾	F=11.66	<0.001
周末	582.9±38.6	597.1±45.6	607.6±37.6	621.8±39.3¹⁾	F=10.27	<0.001

项目	改善组(n=40)	无改善组(n=22)	统计量	P
年龄(x±s)/岁	8.8±2.1	8.7±1.6	t=0.28	0.783
男性[n(%)]	23(57.5)	11(50.0)	χ²=0.32	0.570
每周遗尿夜晚数[M(P₂₅~P₇₅)]
基线	4.0(3.0~5.0)	4.0(3.0~4.0)	Z=1.06	0.287
第4周	3.0(3.0~4.0)	3.0(2.8~4.0)	Z=1.47	0.142
第8周	2.0(2.0~3.0)	3.0(3.0~3.0)	Z=2.84	0.005
第12周	1.5(1.0~2.0)	3.0(3.0~4.0)	Z=4.39	<0.001
遗尿发生时间(x±s)/min
基线	105.3±25.9	118.1±20.7	t=2.00	0.051
第4周	125.9±24.2	127.0±14.2	t=0.20	0.839
第8周	151.6±25.7	135.8±19.7	t=2.51	0.015
第12周	176.5±31.6	160.7±18.4	t=2.15	0.036
平时睡眠时间(x±s)/min
基线	561.5±32.8	563.5±34.5	t=0.23	0.821
第4周	584.0±33.2	566.1±27.2	t=2.17	0.034
第8周	595.8±28.2	572.2±22.6	t=3.37	0.001
第12周	601.0±30.8	579.7±29.5	t=2.64	0.011
周末睡眠时间(x±s)/min
基线	583.6±40.4	581.5±36.1	t=0.21	0.838
第4周	605.2±42.8	582.4±47.9	t=1.92	0.060
第8周	616.7±35.7	590.9±35.8	t=2.73	0.008
第12周	634.7±35.5	598.2±35.3	t=3.89	<0.001
CSHQ总分(x±s)
基线	61.8±4.6	60.0±4.2	t=1.48	0.144
第4周	59.3±5.1	59.3±4.1	t=0.03	0.973
第8周	54.8±4.4	57.7±3.1	t=2.78	0.007
第12周	52.0±4.6	56.7±3.3	t=4.25	<0.001

项目	组别	CSHQ评分				F值	P
项目	组别	基线	第4周	第8周	第12周	F值	P
就寝习惯	改善	12.1±1.1	11.4±1.3	10.3±1.4	9.2±1.3	39.11	<0.001
就寝习惯	无改善	11.7±1.0	11.6±1.2	11.1±0.9	11.1±0.9	2.43	0.071
入睡潜伏期	改善	2.6±0.6	2.4±0.6	1.9±0.5	1.5±0.5	31.52	<0.001
入睡潜伏期	无改善	2.3±0.7	2.2±0.5	2.1±0.5	2.1±0.7	0.68	0.569
睡眠持续时间	改善	6.0±0.8	5.7±0.9	4.9±0.8	4.4±1.0	29.19	<0.001
睡眠持续时间	无改善	5.9±0.8	5.8±0.8	5.5±0.7	5.2±0.7	3.27	0.025
睡眠焦虑	改善	9.9±1.2	9.2±1.4	8.4±1.2	7.8±1.3	21.73	<0.001
睡眠焦虑	无改善	9.3±1.0	9.3±0.9	9.1±1.1	8.6±0.9	2.24	0.089
夜醒	改善	3.8±0.8	4.1±0.8	4.3±0.7	4.6±1.0	7.56	<0.001
夜醒	无改善	4.2±0.7	4.2±0.8	4.2±0.6	4.3±0.8	0.17	0.916
异态睡眠	改善	11.7±1.0	11.4±1.1	10.9±0.9	10.6±1.0	10.20	<0.001
异态睡眠	无改善	11.6±1.1	11.5±1.2	11.1±1.0	10.8±1.0	2.38	0.075
睡眠呼吸暂停	改善	3.5±0.5	3.4±0.5	3.3±0.5	3.5±0.6	2.29	0.080
睡眠呼吸暂停	无改善	3.3±0.5	3.1±0.4	3.2±0.4	3.4±0.5	1.09	0.357
白天嗜睡	改善	12.3±1.3	11.9±1.3	10.9±1.1	10.3±1.3	19.56	<0.001
白天嗜睡	无改善	11.8±1.4	11.6±1.1	11.5±1.1	11.2±1.1	0.93	0.431