• 沒有找到結果。

本研究分析原發性夜間遺尿病人和對照組年紀、性別、身高、身高百分位、

體重、體重百分位、喚醒分數七個變項中發現,原發性夜間遺尿病人的性別以男 性居多,喚醒分數比較高,而在年齡、身高、身高百分位、體重、體重百分位變 項中並無差異。

單一核苷酸鹼基變異方面,多症狀型原發性夜間遺尿包括便秘和白天頻尿分 析傾向5HTR2A變異在統計上有顯著的意義,顯示單一核苷酸多型性的分析可能

和原發性夜間遺尿分別評比較相關。本研究再次驗證了前人的看法,原發性夜間 遺尿是一群複雜的疾病和多基因調控。若是以夜間遺尿整體性的比較,可能因子 太多而更複雜,則較難得到有顯著的結果;須等到收集更多病人才會有出現較有 意義的結論。

參考文獻

1. Wolfish, N. M.: Sleep/Arousal and enuresis subtypes. J Urol, 166: 2444, 2001 2. Loeys, B., Hoebeke, P., Raes, A., Messiaen, L., De Paepe, A., Vande Walle, J.: Does

monosymptomatic enuresis exist? A molecular genetic exploration of 32 families with enuresis/incontinence. BJU Int, 90: 76, 2002

3. Thiedke, C. C.: Nocturnal enuresis.see comment. Am Fam Physician, 67: 1499, 2003

4. Yeung, C. K., Sreedhar, B., Leung, V. T., Metreweli, C.: Ultrasound bladder measurements in patients with primary nocturnal enuresis: a urodynamic and treatment outcome correlation. J Urol, 171: 2589, 2004

5. Baeyens, D., Roeyers, H., Hoebeke, P., Verte, S., Van Hoecke, E., Walle, J. V.:

Attention deficit/hyperactivity disorder in children with nocturnal enuresis. J Urol,

171: 2576, 2004

6. Dehoorne, J. L., Walle, C. V., Vansintjan, P., Raes, A. M., De Guchtenaere, A. R., Van Laecke, E., et al: Characteristics of a tertiary center enuresis population, with special emphasis on the relation among nocturnal diuresis, functional bladder capacity and desmopressin response. J Urol, 177: 1130, 2007

7. Baeyens, D., Roeyers, H., Hoebeke, P., Antrop, I., Mauel, R., Walle, J. V.: The impact of attention deficit hyperactivity disorders on brainstem dysfunction in nocturnal enuresis. J Urol, 176: 744, 2006

8. Tai, H. L., Chang, Y. J., Chang, S. C., Chen, G. D., Chang, C. P., Chou, M. C.: The epidemiology and factors associated with nocturnal enuresis and its severity in primary school children in Taiwan. Acta Paediatr, 96: 242, 2007

9. Rushton, H. G.: Nocturnal enuresis: epidemiology, evaluation, and currently available treatment options. J Pediatr, 114: 691, 1989

10. Cher, T. W., Lin, G. J., Hsu, K. H.: Prevalence of nocturnal enuresis and associated familial factors in primary school children in taiwan. J Urol, 168: 1142, 2002 11. Balat, A., Alasehirli, B., Oguzkan, S., Gungor, M.: Nitric oxide synthase gene

polymorphisms in children with primary nocturnal enuresis: a preliminary study.

Ren Fail, 29: 79, 2007

12. Bayoumi, R. A., Eapen, V., Al-Yahyaee, S., Al Barwani, H. S., Hill, R. S., Al Gazali, L.: The genetic basis of inherited primary nocturnal enuresis: A UAE study. J Psychosom Res, 61: 317, 2006

13. Yeung, C. K., Sit, F. K., To, L. K., Chiu, H. N., Sihoe, J. D., Lee, E., et al:

Reduction in nocturnal functional bladder capacity is a common factor in the pathogenesis of refractory nocturnal enuresis. BJU Int, 90: 302, 2002

14. Eiberg, H., Shaumburg, H. L., Von Gontard, A., Rittig, S.: Linkage study of a large Danish 4-generation family with urge incontinence and nocturnal enuresis. J Urol, 166: 2401, 2001

15. von Gontard, A., Schaumburg, H., Hollmann, E., Eiberg, H., Rittig, S.: The genetics of enuresis: a review. J Urol, 166: 2438, 2001

16. von Gontard, A., Eiberg, H., Hollmann, E., Rittig, S., Lehmkuhl, G.: Molecular genetics of nocturnal enuresis: linkage to a locus on chromosome 22.

Scandinavian Journal of Urology & Nephrology Supplementum, 202: 76, 1999 17. Arnell, H.: The genetics of nocturnal enuresis: a simple question of

complexity.comment. Acta Paediatrica, 87: 487, 1998

18. Eiberg, H.: Total genome scan analysis in a single extended family for primary nocturnal enuresis: evidence for a new locus (ENUR3) for primary nocturnal enuresis on chromosome 22q11. Eur Urol, 33 Suppl 3: 34, 1998

19. Hollmann, E., Von Gontard, A., Eiberg, H., Rittig, S., Lehmkuhl, G.: Molecular genetic, clinical and psychiatric associations in nocturnal enuresis. Br J Urol, 81:

37, 1998

20. von Gontard, A., Eiberg, H., Hollmann, E., Rittig, S., Lehmkuhl, G.: Molecular genetics of nocturnal enuresis: clinical and genetic heterogeneity.see comment.

Acta Paediatrica, 87: 571, 1998

21. Arnell, H., Hjalmas, K., Jagervall, M., Lackgren, G., Stenberg, A., Bengtsson, B., et al: The genetics of primary nocturnal enuresis: inheritance and suggestion of a second major gene on chromosome 12q. J Med Genet, 34: 360, 1997

22. von Gontard, A., Eiberg, H., Hollmann, E., Rittig, S., Lehmkuhl, G.: Genetic heterogeneity in nocturnal enuresis. Am J Psychiatry, 154: 885, 1997

23. Eiberg, H.: Nocturnal enuresis is linked to a specific gene. Scandinavian Journal of Urology & Nephrology Supplementum, 173: 15, 1995

24. Eiberg, H., Berendt, I., Mohr, J.: Assignment of dominant inherited nocturnal enuresis (ENUR1) to chromosome 13q. Nat Genet, 10: 354, 1995

25. Freitag, C. M., Rohling, D., Seifen, S., Pukrop, R., von Gontard, A.:

Neurophysiology of nocturnal enuresis: evoked potentials and prepulse inhibition of the startle reflex. Developmental Medicine & Child Neurology, 48: 278, 2006 26. von Gontard, A., Freitag, C. M., Seifen, S., Pukrop, R., Rohling, D.: Neuromotor

development in nocturnal enuresis. Developmental Medicine & Child Neurology,

48: 744, 2006

27. Iscan, A., Ozkul, Y., Unal, D., Soran, M., Kati, M., Bozlar, S., et al: Abnormalities in event-related potential and brainstem auditory evoked response in children with nocturnal enuresis. Brain Dev, 24: 681, 2002

28. Watanabe, H. and Kawauchi, A.: Locus coeruleus function in enuresis.

Scandinavian Journal of Urology & Nephrology Supplementum, 202: 14, 1999 29. Unal, M., Tataroglu, C., Toros, F., Kanik, A., Pata, Y. S.: Brainstem evaluation in

children with primary nocturnal enuresis. Acta Med Okayama, 58: 1, 2004

30. Kohyama, J., Kumada, S., Shimohira, M., Araki, S., Itoh, M., Iwakawa, Y.:

Nocturnal enuresis and the pontine reticular formation. Eur Urol, 38: 631, 2000 31. Chandra, M., Saharia, R., Hill, V., Shi, Q.: Prevalence of diurnal voiding

symptoms and difficult arousal from sleep in children with nocturnal enuresis. J Urol, 172: 311, 2004

32. Gepertz, S. and Neveus, T.: Imipramine for therapy resistant enuresis: a retrospective evaluation. J Urol, 171: 2607, 2004

33. Medel, R., Ruarte, A. C., Castera, R., Podesta, M. L.: Primary enuresis: a urodynamic evaluation. Br J Urol, 81: 50, 1998

34. Khanna, O. P., Heber, D., Gonick, P.: Cholinergic and adrenergic neuroreceptors in urinary tract of female dogs. Evaluation of function with pharmacodynamics.

Urology, 5: 616, 1975

profile of children with primary nocturnal enuresis. Eur Urol, 33: 41, 1998 36. Eggert, P.: What's new in enuresis? Acta Paediatrica Taiwanica, 43: 6, 2002

37. Cayan, S., Doruk, E., Bozlu, M., Akbay, E., Apaydin, D., Ulusoy, E., et al: Is routine urinary tract investigation necessary for children with monosymptomatic primary nocturnal enuresis? Urology, 58: 598, 2001

38. Cayan, S., Doruk, E., Bozlu, M., Duce, M. N., Ulusoy, E., Akbay, E.: The assessment of constipation in monosymptomatic primary nocturnal enuresis.

International Urology & Nephrology, 33: 513, 2001

39. Soderstrom, U., Hoelcke, M., Alenius, L., Soderling, A. C., Hjern, A.: Urinary and faecal incontinence: a population-based study. Acta Paediatrica, 93: 386, 2004 40. Zaffanello, M., Giacomello, L., Brugnara, M., Fanos, V.: Therapeutic options in

childhood nocturnal enuresis. Minerva Urol Nefrol, 59: 199, 2007

41. Yeung, C. K.: Nocturnal enuresis (bedwetting). Curr Opin Urol, 13: 337, 2003 42. Etele-Hainz, A., Artens, E., Marberger, M.: Therapy concept in enuretic children.

Eur Urol, 33: 49, 1998

43. Kroll, P. and Zachwieja, J.: The system of management nocturnal enuresis based on functional classification. Przegl Lek, 63 Suppl 3: 229, 2006

44. Van Kampen, M., Bogaert, G., Akinwuntan, E. A., Claessen, L., Van Poppel, H., De Weerdt, W.: Long-term efficacy and predictive factors of full spectrum therapy for nocturnal enuresis. J Urol, 171: 2599, 2004

45. Glazener, C. M. and Evans, J. H.: Drugs for nocturnal enuresis in children (other than desmopressin and tricyclics).update in Cochrane Database Syst Rev.

2003;(4):CD002238; PMID: 14583948. Cochrane Database of Systematic Reviews, 002238, 2000

46. Glazener, C. M. and Evans, J. H.: Tricyclic and related drugs for nocturnal enuresis in children.update in Cochrane Database Syst Rev. 2003;(3)

47. Tietjen, D. N. and Husmann, D. A.: Nocturnal enuresis: a guide to evaluation and treatment. Mayo Clin Proc, 71: 857, 1996

48. Eggert, P., Fritz, A., Stecker, B., Muller, D.: Desmopressin has an influence on the arousability of children with primary nocturnal enuresis. J Urol, 171: 2586, 2004 49. Miller, K., Atkin, B., Moody, M. L.: Drug therapy for nocturnal enuresis. Current

treatment recommendations. Drugs, 44: 47, 1992

50. van Kerrebroeck, P. E.: Experience with the long-term use of desmopressin for nocturnal enuresis in children and adolescents. BJU Int, 89: 420, 2002

51. Yang, S. S., Chiou, Y. H., Lin, C. Y., Cher, T. W., Yu, T. J., Lin, A. T., et al:

Treatment guideline of enuresis in Taiwan. Acta Paediatrica Taiwanica, 42: 271, 2001

52. Alessi, N. E., Knight, C. D., Bergs, J. T., Eisner, S. J.: A double-blind, placebo-controlled study of the effect of imipramine on TRH-induced urinary urgency in healthy men. Psychoneuroendocrinology, 17: 223, 1992

53. Glazener, C. M., Evans, J. H., Peto, R. E.: Drugs for nocturnal enuresis in children (other than desmopressin and tricyclics).update of Cochrane Database Syst Rev.

2000;(3):

54. Glazener, C. M., Evans, J. H., Peto, R. E.: Tricyclic and related drugs for nocturnal enuresis in children.update of Cochrane Database Syst Rev. 2000;(3) 55. Mikkelsen, E. J.: Enuresis and encopresis: ten years of progress. Journal of the

American Academy of Child & Adolescent Psychiatry, 40: 1146, 2001

56. Tamayo, M., Fernandez de Gatta, M. M., Garcia, M. J., Dominguez-Gil, A.:

Dosage optimization methods applied to imipramine and desipramine in enuresis treatment. J Clin Pharm Ther, 17: 55, 1992

57. Tamayo, M., Fernandez de Gatta, M. M., Garcia, M. J., Dominguez-Gil, A.:

Population pharmacokinetics of imipramine in children. Eur J Clin Pharmacol, 43:

89, 1992

58. Maggi, C. A., Borsini, F., Lecci, A., Giuliani, S., Meli, P., Gragnani, L., et al:

Effect of acute or chronic administration of imipramine on spinal and supraspinal micturition reflexes in rats. J Pharmacol Exp Ther, 248: 278, 1989

59. Nothwang, H. G., Wirth, J., Brandl, B., Haaf, T., Nielsen, K. B., Tommerup, N., et al: Identification of positional candidates for neurological disorders on chromsome 13q14-->q22. Cytogenet Cell Genet, 79: 293, 1997

60. Volkers, A. C., Heerdink, E. R., van Dijk, L.: Antidepressant use and off-label prescribing in children and adolescents in Dutch general practice (2001-2005).

Pharmacoepidemiol Drug Saf, 2007

61. Steers, W. D. and Lee, K. S.: Depression and incontinence. World J Urol, 19: 351, 2001

62. Ambrosini, P. J., Bianchi, M. D., Rabinovich, H., Elia, J.: Antidepressant treatments in children and adolescents: II. Anxiety, physical, and behavioral disorders. J Am Acad Child Adolesc Psychiatry, 32: 483, 1993

63. Murphy, D. L., Siever, L. J., Insel, T. R.: Therapeutic responses to tricyclic antidepressants and related drugs in non-affective disorder patient populations.

Prog Neuropsychopharmacol Biol Psychiatry, 9: 3, 1985

64. Quist, J. F., Barr, C. L., Schachar, R., Roberts, W., Malone, M., Tannock, R., et al:

Evidence for the serotonin HTR2A receptor gene as a susceptibility factor in attention deficit hyperactivity disorder (ADHD). Mol Psychiatry, 5: 537, 2000 65. Labay, P. and Boyarsky, S.: The action of imipramine on the bladder musculature.

J Urol, 109: 385, 1973

66. Wand, H.: Effect of thymoleptic agents on the motor function of the bladder (animal experiments and clinical studies). Urologe A, 11: 284, 1972

67. Sohn, U. D. and Kim, C. Y.: Suppression of the rat micturition reflex by imipramine. J Auton Pharmacol, 17: 35, 1997

68. Springer, J. P., Kropp, B. P., Thor, K. B.: Facilitatory and inhibitory effects of selective norepinephrine reuptake inhibitors on hypogastric nerve-evoked urethral contractions in the cat: a prominent role of urethral beta-adrenergic receptors. J Urol, 152: 515, 1994

69. Kandil, S. T., Aksu, H. B., Ozyavuz, R.: Reversible nocturnal enuresis in children receiving SSRI with or without risperidone: presentation of five cases. Israel Journal of Psychiatry & Related Sciences, 41: 218, 2004

70. Feeney, D. J. and Klykylo, W. M.: SSRI treatment of enuresis. J Am Acad Child Adolesc Psychiatry, 36: 1326, 1997

71. Took, K. J. and Buck, B. J.: Enuresis with combined risperidone and SSRI use. J Am Acad Child Adolesc Psychiatry, 35: 840, 1996

72. Murray, M. E.: Treatment of enuresis with paroxetine. J Dev Behav Pediatr, 18:

435, 1997

73. Von Gontard, A., Schmelzer, D., Seifen, S., Pukrop, R.: Central nervous system involvement in nocturnal enuresis: evidence of general neuromotor delay and specific brainstem dysfunction. J Urol, 166: 2448, 2001

74. Freitag, C. M., Rohling, D., Seifen, S., Pukrop, R., von Gontard, A.:

Neurophysiology of nocturnal enuresis: evoked potentials and prepulse inhibition of the startle reflex. Developmental Medicine & Child Neurology, 48: 278, 2006 75. Iscan, A., Ozkul, Y., Unal, D., Soran, M., Kati, M., Bozlar, S., et al: Abnormalities

in event-related potential and brainstem auditory evoked response in children with nocturnal enuresis. Brain Dev, 24: 681, 2002

76. Wolfish, N. M.: Sleep/Arousal and enuresis subtypes. J Urol, 166: 2444, 2001 77. Unal, M., Tataroglu, C., Toros, F., Kanik, A., Pata, Y. S.: Brainstem evaluation in

children with primary nocturnal enuresis. Acta Med Okayama, 58: 1, 2004

78. Kohyama, J., Kumada, S., Shimohira, M., Araki, S., Itoh, M., Iwakawa, Y.:

Nocturnal enuresis and the pontine reticular formation. Eur Urol, 38: 631, 2000 79. Hagstroem, S., Kamperis, K., Rittig, S., Rijkhoff, N. J., Djurhuus, J. C.:

Monosymptomatic nocturnal enuresis is associated with abnormal nocturnal bladder emptying. J Urol, 171: 2562, 2004

80. Hunsballe, J. M., Hansen, T. K., Rittig, S., Norgaard, J. P., Pedersen, E. B., Djurhuus, J. C.: Polyuric and non-polyuric bedwetting--pathogenic differences in nocturnal enuresis. Scand J Urol Nephrol Suppl, 173: 77, 1995

圖表

(表一) 臺灣地區原發性夜間遺尿流行病學的研究

2001 BJU International 87, 678–681

初診病人--原發性夜間遺尿評估表

9.現在使用藥物 □無 □有:_____________________

10.從睡眠中甦醒過來的評估分數_________

4.觀察排尿情形 □正常 □異常:______________________

C.實驗室檢查(醫師填寫)

1.必須的 □尿液分析 □尿比重 □腎臟超音波 □BUN/Creatinine □CBC管留全血 2 ㏄

2.選擇性的 □尿液細菌培養 □血清肌酐酸與鈉離子 □K.U.B □餘尿測量 □尿動力學 □口渴測試

□血清抗利尿激素

(圖一) 原發性夜間遺尿的形成三種主要的機轉

(表二) 原發性夜間遺尿候選基因選取(Candidate genes search)

rs13041148 sequence 4 270

rs5195 RFLP 1 Hpy99I 179

RFLP 2

rs9658588 RFLP 1 MspI 289

rs9658587 RFLP 1

rs16888557 RFLP 2 295

(表三)原發性夜間遺尿病童臨床表現和對照組的分析

Enuresis(-) Enuresis(+) P

n=62 n=99

Age (year)

10.58 ± 1.69 10.87 ± 2.82 0.143

Sex (M/F)

32/30 52/47 0.031

Height (cm)

138.85 ± 12.28 132.71 ± 16.5 0.637

percentile

3.35 ± 1.42 3 ± 0.38 0.164

Weight (Kg)

35.25 ± 10.4 33.07 ± 13.80 0.989

percentile

3.16 ± 1.34 3 ± 0.38 0.611

(表四)原發性夜間遺尿病童和正常兒童基因型和基因多型性頻率分析

Nocturnal enuresis Normal subjects P

No. (%) (n=99) No. (%) (n=62) Value*

Genotype

TT 42(42.4) 23(37.1) 0.731

TC 40(40.4) 29(46.8)

CC 17(17.2) 10(16.1)

Allelic frequency

Allele T 82(59.0) 52(57.1) 0.786 Allele C 57(41.0) 39(42.9)

(表五)原發性夜間遺尿病童有無合併頻尿基因型和基因多型性頻率分析

Frequency Non- frequency

P

No. (%) (n=36) No. (%) (n=63) Value*

Genotype

TT 21(58.3) 21(39.6)

0.037

TC 9(25.0) 31(58.4)

CC 6(16.6) 11(20.7)

Allelic frequency

Allele T 30(66.7) 52(55.3) 0.182 Allele C 15(31.3) 42(44.7)

(表六)原發性夜間遺尿病童難喚醒和易喚醒兩組基因型和基因多型性頻率分析

Arousal score

P

6-8 2-5 Value*

(difficultly awaken)

(easily awaken) No. (%) (n=40) No. (%) (n=59)

Nocturnal enuresis patients

P with family history without family history

Value*

Patient No. (%) (n=45) Patient No. (%) (n=54)

(表八)原發性夜間遺尿病童有無便秘其基因型和基因多型性頻率分析

Nocturnal enuresis patients

P with constipation without constipation

Value*

Patient No. (%) (n=33) Patient No. (%) (n=66) Genotype

TT 21(63.6) 21(31.8)

0.010

TC 8(24.2) 32(48.5)

CC 4(12.1) 13(19.7)

Allelic frequency

Allele T 29(70.7) 53(54.1) 0.172 Allele C 12(36.3) 45(45.9)

(表九)5HTR2A 基因多型性在原發性夜間遺尿病童不同的表現型間的分析

Controls NE (Total)

NE with DVS* NE with high arousal score

NE with constipate**

No. patients

Yes No Yes No Yes No (n=62) (n=99) (n=36) (n=63) (n=40) (n=59) (n=33) (n=64) Genotype

TT 23 42 21 21 21 21 21 21

TC 29 40 9 31 15 25 8 32

CC 10 17 6 11 4 13 4 13

Allelic frequency

T 52 82 30 52 36 46 29 53

C 39 57 15 42 19 38 12 45

* Genotype distribution in NE with and without DVS yielded statistically significant differences, P=0.037; * Genotype distribution in NE with constipation yielded statistically differences P=0.010

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