多系统萎缩合并抗利尿激素不适当分泌综合征一例

摘要

探讨多系统萎缩(multiple system atrophy)合并抗利尿激素不适当分泌综合征(syndrome of inappropriate antidiuresis,SIAD)患者的临床特征.回顾性分析本院收治的1例多系统萎缩合并SIAD患者的临床特征及诊治经过.多系统萎缩C型(小脑型)患者,以发热就诊,查有肺部及泌尿系感染.存在持续性等血容量性低钠血症,血渗透压减低、尿钠增高,甲状腺及肾上腺功能无异常,诊断SIAD.肺部及泌尿系感染治愈后发热及SIAD持续存在.患者无汗,体温随室温变化,考虑体温调节中枢受损.经限水治疗,血钠回升至正常低限.结合患者SIAD病程,与感染的相关性,以及患者共存的体温调节受损,考虑SIAD由多系统萎缩导致.尽管多系统萎缩合并SIAD罕见,对多系统萎缩患者水钠平衡仍需关注,而对于多系统萎缩合并肺部感染的患者尤需警惕,须加强水电平衡的管理.%To evaluate the diagnosis and treatment of syndrome of inappropriate antidiuresis ( SIAD ) in multiple system atrophy ( MSA ) . Clinical features and treatment of a case of MSA with SIAD was retrospectively analyzed. An MSA-cerebellar predominant ( MSA-C) type patient was admitted for being fever. Pulmonary and urinary infections were identified. The patient was characterized by euvolaemic hyponatremia with reduced plasma osmolality and increased urine sodium. Hypothyroidism and hypoadrenalism were excluded via functional tests of different hormones. The diagnosis of SIAD was made. The fever and SIAD persisted after pulmonary and urinary infections were cured. The patient was sweatless and the body temperature varied with room temperature due to dysfunction of central thermoregulation. With fluid restriction, the serum sodium return to the lower limit of normal range. Though the SIAD in MSA is rare, water and sodium balance should be carefully maintained, especially for those with pulmonary infection.