异基因造血干细胞移植后的抗利尿激素分泌失调综合征一例报告——附文献复习

Syndrome inappropriate ADH secretion after allogeneic hematopoietic stem cell transplantation:a case report and literature review

目的提高对异基因造血干细胞移植(allo-HSCT)后抗利尿激素分泌失调综合征 (SIADH)的认识,探讨其发病原因。方法报道1例骨髓增生异常综合征难治性贫血伴原始细胞增多型患者allo-HSCT后发生SIADH的临床和实验室特征以及治疗经过。结果患者在allo-HSCT后发生_ 超急性移植物抗宿主病(GVHD),第17天起出现严重低钠血症(血钠最低为103．7 mmol／L)、尿钠增高、血浆渗透浓度降低和尿渗透浓度增高,伴有昏迷和抽搐,诊断为SIADH。经限制入液量和补钠治疗后,患者病情改善,但SIADH始终未被完全纠正,终因移植物被排斥、二次移植后再次发生超急性 GVHD和排斥、继发感染而死亡。结论allo-HSCT后SIADH是一种罕见的、致死性的急性中枢神经系统并发症,为移植相关的多种原因所致,强调对其及时、正确诊治的重要性。

Objective To study the syndrome of inappropriate ADH secretion （SIADH） after allogeneic hematopoietic stem cell transplantation （allo-HSCT） and the possible etiology. Methods The clinical manifestation, laboratory examination, treatment and outcome of a patient with refractory anemia with excess blasts after allo-HSCT were presented. Results Hyperacute graft-versus-host disease （GVHD） was developed in the patient after allo-HSCT followed by severe hyponatraemia （ lowest serum sodium 103.7 mmol/L）, natfiuresis, hypo-osmolality of plasma, hyper-osmolality of urine, coma and twitch at day 17 after allo-HSCT. SIADH was diagnosed. The clinical condition was improved after restriction of water and administration of hypertonic saline, but SIADH was not controlled completely. Afterwards, graft failure was developed. Hyperacute GVHD and graft rejection occurred again after the second transplant. The patient died of secondary infection. Conduslon SIADH after allo-HSCT is a rare fatal acute complication of central nervous system. Numerous transplant-related causes are probably associated with the development of SIADH. Early accurate diagnosis and treatment promptly is of great importance.