恶性肿瘤致抗利尿激素分泌不当综合症的临床分析(附11例报告并文献复习)

Clinical analysis of syndrome of inappropriate antiduretic hormone secretion with malignancy(Report of 11 cases and literature review)

目的:分析抗利尿激素分泌不当综合症(SIADH)的病因、病理生理,及诊断鉴别诊断,探讨恶性肿瘤导致抗利尿激素分泌不当综合症的机制及治疗。方法:对我科近9年11例经病理证实的恶性肿瘤合并SI-ADH患者进行回顾性分析,分析其临床表现、实验室检查及治疗。结果:11例患者中,6例血钠125mmol/L-130mmol/L的患者,在治疗原发病的同时给予限水每天800-1000ml后,3例好转,3例转为持续性无症状慢性低血钠;3例血钠120mmol/L-125mmol/L患者经过限水及补充高浓度氯化钠后血钠恢复正常;2例血钠低于120mmol/L患者,1例经补充氯化钠及病因治疗后好转,1例低钠血症无法纠正,后出现严重肺部感染而死亡。结论:SIADH是导致住院患者发生低钠血症最常见的病因,其中肺癌又是这些病因中最多见的;SIADH的诊断主要是根据实验室检查血钠、尿钠、血渗透压及尿渗透压,其诊断是排除性诊断,需与心、肝、肾等脏器功能异常所致的低钠血症相鉴别;其治疗主要有限水、补充高浓度氯化钠及药物治疗,根本治疗还是病因治疗。

Objective：To study the etiology,pathophysiology and the diagnosis of syndrome of inappropriate antiduretic hormone secretion （SIADH）,and to study the mechanism and treatment of SIADH with malignancy. Methods：A retrospective study was done including reviewing the clinical symptom, the laboratory examination and treatment of 11 eases of SIADH. Results：Six eases with serum sodium concentration between 125mmol/L - 130mmol/L were treated with fluid restriction,3 cases were cured ,3 cases were turned into chronic asymptomatic hyponatremia; 3 cases with serum sodium concentration between 120mmol/L - 125mmol/L were cured with fluid restriction and supplement ofhypertonic sodium chloride; 2 cases with severe hyponatremia （serum sodium concentration 〈 120mmol/L） were treated with fluid restriction and supplement of hypertonic sodium chloride, 1 case was cured , and the other was dead because of severe pulmonary infection. Conclusion ： SIADH is the most common cause of hyponatremia in hospitalized patients, lung cancer is the most common cause of SIADH ;The key points in diagnosing SIADH are serum sodium concentration, tonicity of plasma and urine, urine sodium concentration,it is important to rule out cardiac, liver, and kidney dysfunction in SIADH diagnosis. The treatment are fluid restriction, supplement of hypertonic sodium chloride and medications, treating the underlying etiology is very essential.