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[急性多发性神经根神经炎、暂时性尿崩症与妊娠的关联。附病例报告及文献复习]

[The association of acute polyradiculoneuritis, transitory diabetes insipidus and pregnancy. Apropos of a case and review of the literature].

作者信息

Berteau P, Morvan J, Bernard A M, Verjut J P, Cléophax J P

机构信息

Service de Gynécologie-Obstétrique, Centre Hospitalier Général de Montmorency.

出版信息

J Gynecol Obstet Biol Reprod (Paris). 1990;19(7):793-802.

PMID:2277161
Abstract

This is the first report of the association of transitory diabetes insipidus with acute infective polyneuritis (landry Guillain-Barre Syndrome) occurring in pregnancy. The authors try to establish the inter-relationship between each pathological condition and pregnancy. Polyneuritis in its severe form does not seem to increase the risk of prematurity significantly. The severe forms of more generalised neurological condition as compared with the more limited condition has been noted in the literature but it is not possible to state how pregnancy effects the outcome. Plasma exchange procedures are now possible in pregnant women and the benefits of this treatment have been illustrated in severe forms of polyneuritis. There is difficulty still in selecting what criteria are sufficient to start on a therapy that is not without risk. Finally, the association between transitory diabetes insipidus and pregnancy has been reviewed in the literature and a description is given of the many physiopathological mechanisms associated with it. Diabetes insipidus is rarely found in pregnancy. All authors describe a placental factor with these troubles. The most recent theories suggest that prostaglandins and placental vasopressin are implicated. Treatment is suggested and consists of DDAVP (deamino 8-d-arginine vasopressin), which seems to be the most effective. Close collaboration between the obstetrician, the recovery services and the paediatrician is necessary to get the best results for this very severe pathological condition occurring in pregnancy.

摘要

这是关于妊娠期发生的短暂性尿崩症与急性感染性多发性神经炎(兰德里-吉兰-巴雷综合征)相关性的首例报告。作者试图确立每种病理状况与妊娠之间的相互关系。严重形式的多发性神经炎似乎并未显著增加早产风险。与更局限的病情相比,文献中已提及更广泛神经状况的严重形式,但尚无法说明妊娠如何影响其结局。现在孕妇可以进行血浆置换治疗,且这种治疗的益处已在严重形式的多发性神经炎中得到体现。在选择足以启动有风险的治疗的标准方面仍存在困难。最后,文献中已对短暂性尿崩症与妊娠之间的关联进行了综述,并描述了与之相关的多种生理病理机制。尿崩症在妊娠中很少见。所有作者都描述了与这些病症相关的胎盘因素。最新理论表明前列腺素和胎盘血管加压素与之有关。建议采用去氨加压素(DDAVP)进行治疗,它似乎是最有效的。产科医生、康复服务人员和儿科医生之间密切合作对于在妊娠期出现的这种非常严重的病理状况取得最佳治疗效果很有必要。

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