夜間多尿に伴う夜間頻尿に対する酢酸デスモプレシンの効果に関する検討

Abstract

夜間多尿に伴う夜間頻尿の患者12例(男性10例, 女性2例, 平均年齢67歳)に対して, 酢酸デスモプレシン(l0μg)鼻腔内噴霧を2週間行い, その治療効果について検討した.治療前後の排尿状況, 尿の性状, 使用状況, 合併症などを調査した結果, 平均夜間尿量は928mlから469mlに, 平均夜間尿回数は4.8回から2.8回に減少した.平均早朝尿浸透圧は420から598mOsm/kgに上昇し, 平均尿中Na濃度は100から140mEq/lに上昇した.平均血中Na濃度は141から135mEq/lに低下した.夜間平均一回排尿量, 昼間尿量は治療前後で変化がなかった.平均5ヵ月の観察期間中10例に効果がみられ, このうち5例は服薬中止後も症状の軽快が継続した.顔面浮腫を認めた1例は使用を中止し, 一過性の低Na血症3例と頭痛1例については, 前者が夜間水分制限指導下に使用を継続して軽快し, 後者も使用下に軽快した.本治療薬は副作用に注意することで, 夜間多尿に伴う夜間頻尿に対する治療の選択肢の1つになりうると考えられた

Older adults often cite nocturia as one of the most bothersome lower urinary tract symptoms (LUTS). We investigated the efficacy and safety of intranasal desmopressin in the treatment of nocturia due to nocturnal polyuria on 12 patients (ten men, two women) ranging in age from 53 to 77 years (mean 67 years). All patients experienced more than two episodes of nocturia per night, and had a nocturnal urine volume greater than 35% of the daily voided volume, measured using a 3-day voiding diary with a frequency-volume chart. They began taking intranasal desmopressin (10 microg) at bedtime. When compared with the baseline data, the nocturnal urine volume, (928 +/- 307 versus 469 +/- 251 ml, p = 0.0007) and nocturnal frequency (4.8 +/- 2.0 versus 2.8 +/- 1.8, p = 0.0009) were significantly decreased. The daytime urine volume (1, 008 +/- 458 versus 930 +/- 419 ml, p = 0.49) did not change significantly. The unine osmolarity (420 +/- 143 versus 598 +/- 158 mOsm/kg, p = 0.0065), and urine sodium levels (100 +/- 32 versus 140 +/- 60 mEq/l, p = 0.007) increased significantly, whereas the serum sodium levels (141 +/- 3 versus 135 +/- 7 mEq/l, p = 0.048) decreased significantly. Among the 12 patients, 5 (41.6%) patients reported side effects, including headache in 1, edema in 1 and hyponatremia in 3. The patient with edema discontinued medication, but the other 4 patients continued their medication and the side effects subsided. In conclusion, desmopressin is an effective treatment for adult patients complaining of nocturia due to nocturnal polyuria. One should be aware of the potential side effects including hyponatremia.