小细胞肺癌并发抗利尿激素分泌不当综合征的临床特点研究

Syndrome of inappropriate secretion of antidiuretic hormone in patients with small-cell lung cancer

目的:研究不同分期小细胞肺癌(SCLC)合并抗利尿激素分泌不当综合征(SIADH)的临床特点的异同。方法:回顾性分析10年间我院268例SCLC中16例(16/268,5.97%)合并SIADH的患者的临床资料,按局限期(7例)和广泛期(9例)分为2组。结果:50%的患者低钠血症起病,比发现肿瘤的时间要早0.5个月～5个月;43.75%的患者无特殊临床症状;56.25%的患者在2个周期有效化疗后血钠值恢复正常,无组间差异;总生存期与血钠最低值正相关,与纠正低钠血症的时间呈负相关;女性、减重、ECOG评分、血钠值、纠正低钠血症的时间、总生存期患者等在广泛期显示出比局限期更差的结果(P<0.05)。结论:SIADH提示SCLC的潜在可能;有效治疗SCLC合并的SIADH首先要有效控制肿瘤;低钠血症的程度及其对治疗的反应等因素可以预测SCLC的预后。

Objective：To determine and compare the prognosis of patients with limited and extensive stage small-cell lung cancer（SCLC） and syndrome of inappropriate secretion of antidiuretic hormone（SIADH）.Methods：Review of clinical data from 268 patients with SCLC revealed SIADH in 16 patients（5.97%）from 1998 to 2008.Seven patients in the limited stage,and 9 patients in the extensive stage.Median of age of patients was 62 years,and 13 （81.25%）were males.Results：SIADH occurred most often with initial presentation 50%（8 of 16）,and resolved promptly （less than 6 weeks）with initiation of combination chemotherapy in 56.25% of evaluable patients,and showed no correlation with clinical stage.Nine （56.25%）patients showed symptoms of water intoxication at the time of diagnosis,and 43.75% patients had no special clinical symptoms.The total survival correlated with blood sodium minimum value and negatively correlated with the time of restore the hyponatremia.The female,weight loss and Eastern Cooperative Oncology Group Score,hyponatremia severity and time of restore to the normal,and total survival,were comparable between the two groups,showed that extensive-stage patients had a worse outcome （P〈0.05）.Conclusion：SIADH is an acceptable prognostic sign in SCLC.Patients with unexplained SIADH should be meticulously scrutinized for a possible malignancy.Successful treatment of the underlying tumor,will usually result in prompt disappearance of the SIADH.Hyponatremia severity and time spend in restore are poor prognostic factors in SCLC.