两性霉素B相关肾性尿崩症临床及文献病例分析

Clinical and literature analysis of amphotericin B-associated nephrogenic diabetes insipidus

目的了解两性霉素B(AmB)相关肾性尿崩症(NDI)的临床特征、处置方案和预后情况。方法报道天津医科大学总医院收治的1例AmB相关NDI患者的诊治经过,并对该例以及检索中国知网、万方医学、维普数据库和PubMed、Web of Science、ScienceDirect等数据库(截至2023年8月22日)收集到的AmB相关NDI病例的主要临床资料(性别、年龄、原发病、用药情况、NDI发生情况以及处置和转归),进行描述性分析。结果纳入分析的患者共11例,男性7例,女性4例,平均年龄41岁,范围12~66岁。AmB与NDI关联性评价7例为很可能,4例为可能。开始用药至发生NDI的时间为3 d~3周,尿量3.8~10.8 L/d。6例患者伴发低钾血症,5例患者出现血肌酐升高。11例患者中,9例患者因病情需要未停用AmB,4例详细描述了干预方案,给予对症处理后完成了AmB治疗,7例NDI治愈或好转,2例死亡。2例停药者,1例症状明显改善后再次启用AmB,未再复发;另1例停药后好转,再次启用后NDI复发但未停药,患者死于原发病。结论使用AmB过程中应密切关注是否有NDI的发生。出现NDI后多数患者可不停药,给予对症治疗后预后良好。

Objective To investigate the clinical features,management,and prognosis of amphotericin B(AmB)?associated nephrogenic diabetes insipidus(NDI).Methods The diagnosis and treatment process of a patient with AmB?related NDI who was admitted to the General Hospital of Tianjin Medical University was reported,and the main clinical data of the patient and related cases such as gender,age,primary disease,medication,NDI occurrence,treatment and outcome collected from CNKI,Wanfang Medical,and VIP databases,PubMed,Web of Science,and ScienceDirect(up to August 22,2023)were analyzed descriptively.Results A total of 11 patients were included in the analysis,including 7 males and 4 females,with an average age of 41 years,ranging from 12 to 66 years.The correlation between AmB and NDI was probable in 7 cases and possible in 4 cases.The time from the beginning of medication to the occurrence of NDI was 3 days to 3 weeks,and the urine volume was 3.8-10.8 L/d.Among the 11 patients,6 patients had hypokalemia and 5 patients had elevated serum creatinine;9 patients did not stop using AmB due to their conditions,the intervention plans were described in details in 4 patients and AmB treatments were completed after symptomatic treatments,7 patients were cured or improved,and 2 patients died.Among the 2 patients who stopped taking the medication,1 patient showed significant improvement in symptoms and resumed using AmB without recurrence;the other case was improved after stopping the medication,but relapsed after resuming use without stopping the medication,and the patient died from the primary disease.Conclusions During the use of AmB,close attention should be paid to the occurrence of NDI.After occurrence of NDI,most patients can continue taking the AmB and have a good prognosis after symptomatic treatments.