异基因造血干细胞移植后的抗利尿激素分泌失调综合征

Syndrome of Inappropriate Antidiuretic Hormone （ADH） Secretion after Allogeneic Hematopoietic Stem Cell Transplantation

目的提高异基因造血干细胞移植（allo-HSCT）后的抗利尿激素分泌失调综合征（SIADH）的认识，探讨其病因及诊疗方法。方法报道1例慢性粒细胞性白血病患者行allo-HSCT后发生SIADH的诊疗经过。结果患者在移植后第5d发生超急性移植物抗宿主病，予糖皮质激素治疗后控制．移植后第18d出现烦躁、抽搐等中枢神经系统症状，出现严重的低钠血症，并呈进行性下降，血渗透压明显下降，尿钠及尿渗透压明显升高，血渗透压小于尿渗透压，诊断SIADH，予以限制人液量，补充钠盐，及其他对症治疗后血钠有所上升，但中枢神经系统症状无好转，患者家属要求自动出院。结论allo-HSCT后SIADH罕见，起病隐匿，病情发展迅速，早期的正确诊断和治疗有利于改善其预后。

Objective To study the syndrome of inappropriate ADH secretion （SIADH） after allogeneic hematopoietic stem cell transplantation （alIo-HSCT）, the etiology, the diagnosis and the treatment.Methods SIADH occurring in one patient with chronic myelocytic leukemia were reported after HLA-mismatched related alio-HSCT. Results Hyperacute graft-versus-host-disease （GVHD） was developed at ＋5d after alIo-HSCT.The hyperacute GVHD was controlled with glucocorticoids.The patient bad the symptoms of irritability-restlessness and convulsion, and severe hyponatremia was developed to natriuresis,hypo-osmolality of plasma, hyper-osmolality of urin at ＋lSd after allo-HSCT. SIADH was diagnosed. The hyponatremia was improved after restriction of water and administration of hypertonic saline,but it was not controlled completely.The clinical condition of central nervous system was not improved,then the patient＇s family give up the treatment.Conclusions SIADH after alIo-HSCT is a rare fatal acute complication.Its onste was insidious and development was very fast.Early accurate diagnosis and prompt treatment are very important for its prognosis.