心肾综合征低钠血症患者抗利尿激素测定及高渗盐水强化利尿的疗效

The assay of antidiuretic hormone in cardio-renal syndrome with hyponatremia and the effect of aggressive diuresis with hypertonic saline solution

目的:探讨抗利尿激素(ADH)在心肾综合征(CRS)伴低钠血症中的作用及高渗盐水强化利尿(HS+aggDiu)对心肾功能和ADH释放的影响。方法:CRS伴低钠血症患者25例,测定其血浆ADH水平。将患者随机分为(HS+aggDiu)13例和单纯强化利尿组(aggDiu组)12例,分别给予高渗盐水并大剂量呋塞米静脉滴注和单纯大剂量呋塞米静脉滴注,记录2组患者心肾功能、水钠潴留和血钠的变化。结果:HS+aggDiu组尿量增加、体重减轻、血肌酐下降、NYHA心功能分级改善等方面显著改善、水钠潴留减轻,血钠水平升高,其疗效显著优于aggDiu组。同时,血ADH水平并未随着血钠和渗透压的恢复而明显升高,说明HS+aggDiu减少了ADH的非渗透性释放。结论:CRS伴低钠血症与ADH的非渗透性释放有关;可有效减轻水钠潴留,改善心肾功能,并减轻ADH的非渗透性释放。

Objective:To explore the role of antidiuretic hormone(ADH)in the pathogenesis of cardio-renal syndrome with hyponatremia and to explore the effect of aggressive diuresis with hypertonic saline solution(HS).Method:Twenty-five patients were recruited and all the levels of ADH were assayed.Patients were randomly divided into HS+aggDiu group and aggDiu group.In HS+aggDiu group,the 13 patients were treated with HS and high dose of furosemide while in aggDiu group,12 patients were used with only the same dose of furosemide.The parameter of cardiac and renal function,volume retention,and serum sodium were recorded and analyzed before and after treatment.Result:Aggressive diuresis with HS significantly improved the cardiac and renal function(included the urinary volume increase,body weight decrease,creatinine decrease,NYHA cardiac function improvement),alleviated the volume retention and resumed the serum sodium,which were better than in aggDiu group.The level of ADH did not increase with the increase of serum sodium,which indicated that the aggressive diuresis with HS can diminished the release of ADH by nonosmolar stimuli.Conclusion:The inappropriate release of ADH plays a role in the pathogenesis of cardio-renal syndrome with hyponatremia.Aggressive diuresis with HS can reduce the volume retention,improve the cardiac function,resume the sodium concentration,and inhibit the ADH nonosmolar release effectively.