4例中枢性尿崩症合并高渗高血糖综合征病例分析

Case analysis of 4 patients with CDI combined with HHS

目的:与单纯性高渗高血糖综合征(hyperosmolar hyperglycemic syndrome,HHS)比较,探讨HHS合并中枢性尿崩症(central diabetes insipidus,CDI)患者的临床特点。方法:回顾分析近年来我院收治的单纯HHS患者11例(HHS组)以及CDI合并HHS 4例患者(合并组)的临床资料。结果:12组间性别、BMI、收缩压、舒张压、血BUN/Cr无统计学差异(P>0.05),HHS组的平均年龄高于合并CDI组(P<0.05)。2与HHS组比较,入院时合并组的血糖、血钠、血渗透压、尿比重、尿渗透压均无统计学差异(P>0.05)。扩容后,2组血糖均明显下降,但合并组血钠及血渗透压显著高于HHS组(P<0.05),尿比重及尿渗透压显著低于HHS组(P<0.05)。结论:单纯HHS与合并CDI的HHS患者临床表现和实验室检查有相似之处,当HHS患者补液、降血糖后高血钠未及时纠正,应考虑HHS合并CDI的可能。

Objective：To investigate the clinical characteristics of hyperosmolar hyperglycemic syndrome（HHS）combined with central diabetes insipidus（CDI）in comparison with HHS. Methods：The clinical information of 11 patients diagnosed with HHS（HHS group）and 4 patients diagnosed with CDI combined with HHS（combination group）were retrospectively analyzed. Results：①There was no difference in sex,BMI,SBP,DBP and BUN/Cr between the two groups（P〉0.05）,while the mean age of HHS group was higher than that of the combination group（P〈0.05）. ②When admitted to the hospital,the blood glucose,serum sodium,serum osmolality,urine specific gravity and urine osmolality of the patients in the combination group has no difference compared with those of HHS group（P〉0.05）. After rehydration therapy,the blood glucose decreased in both groups. However,in the combination group,the serum sodium and osmolality were significantly higher than that of HHS group（P〉0.05）;the urine specific gravity and urine osmolality were obviously lower than that of HHS group（P〉0.05）. Conclusion：The clinical manifestations and laboratory investigations in patients who suffered from HHS combined with CDI are similar to those with HHS only. When the hypernatremia in HHS patients can＇t be improved effectively after the rehydration and hypoglycemic therapy,we should take the HHS combined with CDI into consideration.