抗利尿激素分泌不當症候羣之臨床分析

Clinical Analysis of the Syndrome of Inappropriate Secretion of Antidiuretic Hormone

陳銘華(Ming-Hwa Chen) ； 黃富源(Fu-Yuan Huang) ； 沈淵瑤(Ein-Yiao Shen) ； 邱世昌(Shr-Chang Chyou) ； 何文佑(Man-Yau Ho) ； 吳文豪(Wen-Haur Wu)

《Acta Paediatrica Sinica》 27卷5期 (1986/10) Pp. 445-451

摘要

馬偕紀念醫院小兒科自民國72年9月至74年10月3年間，有16病例被診斷為抗利尿黴素分泌不當症候羣。其中男13例，女3例，男比女4.3:1。年齡分佈以新生兒期7例(43.8%)為最多。其潛在病因，與中樞神經疾病有關者佔14例(87.6%)，與肺炎有關者2例(12.5%)。在中樞神經疾病中，較常見的是結核性腦膜炎與新生兒窒息，各有5例（各佔31.2%）。其餘，日本腦災，散播性血管內凝集合併腦出血、綠膿稈菌腦膜炎與病毒性腦病變各有1例。實驗室檢查，16例的血清鈉為110至129mEq/L不等，平均是121±5.3mEq/L。血清滲透壓為240至278mosm/kg，平均是257.8±11.2mosm/kg。尿液滲透壓為148至829mosm/kg,平均是399.4±182.6mosm/kg。其中13例，尿液滲透壓大於血清滲透壓。16例當中，1例自動出院，1例死亡，其餘14例存活。這14例出院後，追蹤期間由二分之一至三又二分之一個月不等，平均為1.33±0.77個月。追蹤結果，發現神經學後遺症者有7例，其住院時低血鈉期間平均是17.29±18.71天。而另外7例無後遺症者，平均是2.29±0.76天。統計學上發現，低血鈉症期間超過2天者，比較容易發生神經學之後遣症。(Fisher’s exact test, P=0.002)。為了避免水中毒與肺水腫，提高警覺，早期診斷與早期治療是重要的。

並列摘要

During the past three years (1983-1985), 16 cases with the syndrome of inappropriate secretion of antidiuretic hormone (SIADH) were encountered in the Department of Pediatrics, Mackay Memorial Hospital. Thirteen cases were male and three female. Their ages ranged from 3 days to 14 years, with a peak in the neonatal period (7/16, 43.8%). The underlying disease were CNS diseases in 14 cases and pneumonia in 2 cases. Among patients with CNS diseases, there were TB meningitis (5 cases); neonatal asphyxia (5 cases); and Japanese B encephalitis, disseminated intravascular coagulation with intracranial hemorrhage, pseudomonas meningitis, and viral encephalopathy (1 case each). Serum sodium ranged from 110 to 129 mEq/L (mean: 121±5.3 mEq/L), with serum osmolality from 240 to 278 mosm/kg (mean: 257.8±11.2 mosm/kg) and urine osmolality from 148 to 829 mosm/kg (mean: 399.4±182.6mosm/kl). In 13 of the 16 cases, urine osmolality was greater than serum osmolality. Among the 14 patients followed-up for one half month to three one half months, 7 had neurologic sequalae; no neurologic anomaly was noted in the other 7 patients. The mean duration of hyponatrernia during admission in the 7 cases with neurologic sequalae was 17.29±18.71 days; however, in the 7 cases without neurologic sequalae, it was 2.29±0.71 days. Statistically, a prolonged depression of serum sodium (more than 2 days), despite fluid restriction, correlated significantly with the presence of neurologic sequalae of the disease. To prevent cerebral and pulmonary edema, early diagnosis and treatment are crucial.

並列關鍵字

syndrome of inappropriate secretion of antidiuretic hormone ； hyponatremia ； urinary osmotic pressure