多系统萎缩合并抗利尿激素分泌不当综合征1例及文献复习

doi:10.3969/j.issn.1004-583X.2022.05.012

临床荟萃 ›› 2022, Vol. 37 ›› Issue (5): 451-454.doi: 10.3969/j.issn.1004-583X.2022.05.012

多系统萎缩合并抗利尿激素分泌不当综合征1例及文献复习

邱建美¹, 申红霞², 王德峰²()

1.河北工程大学临床医学院,河北邯郸 056002
2.河北工程大学附属医院内分泌科,河北邯郸 056029

收稿日期:2021-12-31 出版日期:2022-05-20 发布日期:2022-06-22
通讯作者: 王德峰 E-mail:wdf991217@126.com
基金资助:
河北省直医疗卫生机构老年病防治项目——邯郸市丛台区2型糖尿病患者现状调查与分析(361037)

Multiple system atrophy complicated with syndrome of inappropriate antidiuresis: A case report and literature review

Qiu Jianmei¹, Shen Hongxia², Wang Defeng²()

1. Clinical Medical College, Hebei University of Engineering, Handan 056002, China
2. Department of Endocrinology, Affiliated Hospital of Hebei Engineering University, Handan 056029, China

Received:2021-12-31 Online:2022-05-20 Published:2022-06-22
Contact: Wang Defeng E-mail:wdf991217@126.com

摘要/Abstract

摘要：

目的探讨多系统萎缩(multiple system atrophy,MSA)合并抗利尿激素分泌不当综合征(syndrome of inappropriate antidiuresis,SIAD)的临床特征,为该病的临床诊断及治疗提供依据。方法回顾性分析1例MSA合并SIAD患者的临床资料、诊疗经过并复习相关文献。结果患者为男性,58岁,间断意识障碍伴咳嗽、咳痰1月余,再发2天。结合患者病史、体格检查及辅助检查,入院诊断:①重度低钠血症;②肺部感染;③MSA。后完善相关辅助检查并结合其临床表现,确诊为SIAD。给予抗感染、限水、补钠等治疗后,患者肺部感染治愈,但低钠血症仍持续存在。结论 MSA可能是SIAD病因,而肺部感染可能是MSA合并SIAD的易感因素。对MSA患者,尤其是合并肺部感染时应加强水钠平衡管理。

关键词: 多系统萎缩, 抗利尿激素分泌不当综合征, 低钠血症

Abstract:

Objective To provide evidences for clinical diagnosis and treatment of multiple system atrophy (MSA) complicated with the syndrome of inappropriate antidiuresis (SIAD) by exploring clinical features of the disease. Methods The clinical data, diagnosis & treatment process of a patient with MSA complicated with SIAD were retrospectively analyzed, and relevant literature was reviewed. Results The patient was a 58-year-old male with intermittent disturbance of consciousness accompanied by cough and sputum for more than 1 month, and then underwent the disease attack for 2 days. In combination with the patient's medical history, physical examination and auxiliary examination, the following findings of admission diagnosis were made: ①Severe hyponatremia; ②Pulmonary infection; ③ MSA. The patient was confirmed to have SIAD after supplementing relevant auxiliary examination and combining corresponding clinical manifestations. The patient's pulmonary infection was cured except for persistent hyponatremia after therapies including anti-infection, water fasting and sodium supplementation. Conclusion MSA may be the cause of SIAD, and pulmonary infection may be the susceptible factor of SIAD complicated with MSA. The control over water-sodium balance should be strengthened for patients with MSA, especially the cases complicated with pulmonary infection.

Key words: multiple system atrophy, syndrome of inappropriate antidiuresis, hyponatremia

中图分类号:

R587.1

邱建美, 申红霞, 王德峰. 多系统萎缩合并抗利尿激素分泌不当综合征1例及文献复习[J]. 临床荟萃, 2022, 37(5): 451-454.

Qiu Jianmei, Shen Hongxia, Wang Defeng. Multiple system atrophy complicated with syndrome of inappropriate antidiuresis: A case report and literature review[J]. Clinical Focus, 2022, 37(5): 451-454.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.05.012

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I5/451

图/表 2

参考文献 18

[1]	Koga S, Dickson DW. Recent advances in neuropathology,biomarkers and therapeutic approach of multiple system atrophy[J]. J Neurol Neurosurg Psychiatry, 2018, 89(2):175-184. doi: 10.1136/jnnp-2017-315813 URL
[2]	Moritz ML. Syndrome of inappropriate antidiuresis[J]. Pediatr Clin North Am, 2019, 66(1):209-226. doi: 10.1016/j.pcl.2018.09.005 URL
[3]	Cuzzo B, Padala SA, Lappin SL. Physiology, vasopressin[EB/OL]. [2021-8-27]. https://pubmed2.ilibs.cn/books/NBK526069.
[4]	Spasovski G, Vanholder R, Allolio B, et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia[J]. Eur J Endocrinol, 2014, 170(3):G1-47. doi: 10.1530/EJE-13-1020 URL
[5]	Peri A, Giuliani C. Management of euvolemic hyponatremia attributed to SIADH in the hospital setting[J]. Minerva Endocrinol, 2014, 39(1):33-41. pmid: 24513602
[6]	Cuesta M, Garrahy A, Thompson CJ. SIAD:Practical recommendations for diagnosis and management[J]. J Endocrinol Invest, 2016, 39(9):991-1001. doi: 10.1007/s40618-016-0463-3 pmid: 27094044
[7]	Fanciulli A, Stankovic I, Krismer F, et al. Multiple system atrophy[J]. Int Rev Neurobiol, 2019, 149:137-192.
[8]	Palma JA, Norcliffe-Kaufmann L, Kaufmann H. Diagnosis of multiple system atrophy[J]. Auton Neurosci, 2018, 211:15-25. doi: 10.1016/j.autneu.2017.10.007 URL
[9]	Gilman S, Wenning GK, Low PA, et al. Second consensus statement on the diagnosis of multiple system atrophy[J]. Neurology, 2008, 71(9):670-676. doi: 10.1212/01.wnl.0000324625.00404.15 pmid: 18725592
[10]	Burns MR, McFarland NR. Current management and emerging therapies in multiple system atrophy[J]. Neurotherapeutics, 2020, 17(4):1582-1602. doi: 10.1007/s13311-020-00890-x URL
[11]	Nagumo K, Kita K, Kitano K, et al. Shy-Drager syndrome and the syndrome of inappropriate secretion of antidiuretic hormone[J]. Rinsho Shinkeigaku, 1992, 32(2):177-181.
[12]	Samukawa M, Hirano M, Sakanoto H, et al. Risks of inappropriate secretion of antidiuretic hormone in multiple system atrophy[J]. Mov Disord, 2011, 26(14):2572-2573. doi: 10.1002/mds.23904 URL
[13]	谢曼青, 张燕, 王含, 等. 多系统萎缩伴抗利尿激素分泌不当综合征三例临床分析[J]. 中国现代神经疾病杂志, 2017, 17(2):133-137.
[14]	苏停停, 刘洁, 高璐, 等. 多系统萎缩合并抗利尿激素不适当分泌综合征一例[J]. 中华内分泌代谢杂志, 2019, 35(6):511-514.
[15]	葛均波, 徐永健, 王辰. 内科学[M]. 9版. 北京: 人民卫生出版社, 2018:677.
[16]	Sahu A, Dube MG, Kalra SP, et al. Bilateral neural transections at the level of mesencephalon increase food intake and reduce latency to onset of feeding in response to neuropeptide Y[J]. Peptides, 1988, 9(6):1269-1273. pmid: 3247249
[17]	Sone H, Okuda Y, Bannai C, et al. Syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and Gerhardt syndrome associated with Shy-Drager syndrome[J]. Intern Med, 1994, 33(12):773-778. doi: 10.2169/internalmedicine.33.773 URL
[18]	Frouget T. The syndrome of inappropriate antidiuresis[J]. Rev Med Interne, 2012, 33(10):556-566. doi: 10.1016/j.revmed.2012.07.005 pmid: 22884285

患者编号	性别	年龄 (岁)	病史 (年)	诊断类型	血清钠 (mmol/L)	血浆渗透压 (mOsm/L)	尿渗透压 (mOsm/L)	24小时尿钠 (mmol/L)	合并症
1	男	53	2	MSA-C	122	258	945	209	肺炎
2	男	62	3	MSA-P	123	280	457	91	肺炎
3	男	59	4	MSA-C	118	-	-	144	肺炎
4	男	53	5	MSA-P	121	-	-	129	无
5	女	61	9	MSA-C	99	205	474	-	肺炎
6	男	52	4	MSA-P	127	262	319	-	无
7	男	67	11	MSA-P	124	255	420	-	心脏起搏器
8	男	52	10	MSA-C	120	246	381	-	发热
9	男	76	1.5	MSA-P	118	244	304	-	无
10	女	62	8	MSA-C	118	254	-	-	呼吸暂停
11	女	58	6	MSA-P	116	-	722	-	肾盂肾炎
12	男	67	11	MSA	124	268	500	-	呼吸暂停

患者编号	性别	年龄 (岁)	病史 (年)	诊断类型	血清钠 (mmol/L)	血浆渗透压 (mOsm/L)	尿渗透压 (mOsm/L)	24小时尿钠 (mmol/L)	合并症
1	男	53	2	MSA-C	122	258	945	209	肺炎
2	男	62	3	MSA-P	123	280	457	91	肺炎
3	男	59	4	MSA-C	118	-	-	144	肺炎
4	男	53	5	MSA-P	121	-	-	129	无
5	女	61	9	MSA-C	99	205	474	-	肺炎
6	男	52	4	MSA-P	127	262	319	-	无
7	男	67	11	MSA-P	124	255	420	-	心脏起搏器
8	男	52	10	MSA-C	120	246	381	-	发热
9	男	76	1.5	MSA-P	118	244	304	-	无
10	女	62	8	MSA-C	118	254	-	-	呼吸暂停
11	女	58	6	MSA-P	116	-	722	-	肾盂肾炎
12	男	67	11	MSA	124	268	500	-	呼吸暂停

多系统萎缩合并抗利尿激素分泌不当综合征1例及文献复习

Multiple system atrophy complicated with syndrome of inappropriate antidiuresis: A case report and literature review

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