儿童急性淋巴细胞白血病化疗后抗利尿激素分泌异常综合征临床分析

Clinical analysis of SIADH after chemotherapy in childhood ALL

目的 对急性淋巴细胞白血病（ALL）化疗后出现抗利尿激素分泌异常综合征（SIADH）患儿的临床资料进行分析,探讨SIADH发病特点,以提高对该病的认识,利于临床诊治。方法 收集我院血液肿瘤科2011年1月-2014年6月ALL化疗后合并SIADH患儿的资料,进行分析总结。结果 ALL患儿规律治疗103例,发生SIADH 13例,发病率12.6%。男∶女=2.25∶1,发病中位年龄5（1～15）岁。13例患儿在全程化疗中共出现23次低钠事件,5例（38.5%）1次,8例（61.5%）2次以上。有临床症状11次（47.8%）,无临床症状12次（52.2%）。平均血钠水平127.21±7.22 mmol/L。发生于VDLD诱导缓解阶段10次,CAM巩固阶段5次,Block1强化治疗阶段1次,Block2强化治疗阶段1次,VALD再诱导阶段6次。低钠血症持续时间1～19 d,平均5.73±4.32 d。地塞米松、长春新碱、左旋门冬酰胺酶、柔红霉素、阿霉素、环磷酰胺、甲氨蝶呤、异环磷酰胺及长春地辛均为可能诱发SIADH药物。结论 儿童ALL化疗后SIADH并不罕见,经严密观察,必要时限制液体等处理,预后良好。

Objective To analyze the clinical data and explore the characteristics of SIADH after chemotherapy in childhood ALL, and then to improve the understanding, diagnosis and treatment of this complication. Methods Clinical data was collected and analyzed in patients with SIADH after chemotherapy during January 2011 to June 2014 in hematology and oncology department of Shenzhcn Children＇ s Hospital. Results There were 103 children with ALL who received regular chemotherapy, in which 13 cases occurred SIADH, the incidence was 12.6%. The ratio of male to female was 2.25：1. Their median age was 5 years （range： 1-15）. There were 23 episodes of hyponatremia in the 13 SIADH cases, in which 5 patients （38.5%） occurred once while 8 patients （61.5%）occurred more than one time. Clinical symptoms appeared in 11 episodes （47.8%） ,while 12 episodes （52.2%）of hyponatremia showed asymptomatic. In all episodes, the average serum sodium level was 127.21 ±7.22 mmol/L. Ten episodes of SIADH were observed in the stage of VDLD remission induction, 5 episodes in the stage of CAM consolidation, 1 episode in the stage of Block 1 and Block 2 intensive treatment and 6 episodes in the stage of VALD re-induction. The average duration of hyponatremia was 5.73 ±4.32 days （range ： 1-19） in these 23 episodes. SIADH probably caused by dexamethasone, vincristine, L-asparaginase, daunomycin, doxorubicin, cyclophosphamide, methotrexate, ifosfamide and vindesine. Conclusions SIADH secondary to chemotherapy in childhood ALL is not rare, but the prognosis is favorable through close observation and fluid restriction when necessary.