Pu Shuxiang, Long Youming, Yang Ning, He Yihua, Shan Fulan, Fan Yongxiang, Yin Jianrui, Gao Qingchun, Cong Gao
Department of Neurology, The Second Affiliated Hospital of Guangzhou Medical University, 250# Changgang East Road, Guangzhou, 510260, Guangdong, China.
J Neurol. 2015 Jan;262(1):101-7. doi: 10.1007/s00415-014-7537-y. Epub 2014 Oct 15.
The objective of this study was to analyze the frequency of syndrome of inappropriate antidiuretic hormone secretion (SIADH) in patients with positive aquaporin-4 (AQP4) antibodies and evaluate the relationship between SIADH and hypothalamic lesions in patients with NMO and NMO spectrum disorder (NMOSD). AQP4 antibodies were tested by an indirect immunofluorescence assay employing HEK-293 cells transfected with recombinant human AQP4. Clinical data of patients were analyzed retrospectively. In total, 192 patients with AQP4 antibodies were certified, of which 41 patients (21.4 %) were included in the present study. Six patients (14.6 %, 6/41) met the criteria of SIADH, of which hyponatremia was mild in one patient, and severe in five. Five patients experienced confusion or decreased consciousness. Four patients were diagnosed with NMO and two were diagnosed with recurrent optic neuritis. Magnetic resonance imaging showed 11 of 41 patients (26.8 %) had hypothalamic lesions. All patients with SIADH had hypothalamic abnormalities. Hyponatremia resolved in all patients after intravenous methylprednisolone and intravenous immunoglobulin therapy. SIADH is not rare in patients with NMO/NMOSD, especially in patients with lesions close to the hypothalamus.
本研究的目的是分析水通道蛋白4（AQP4）抗体阳性患者中抗利尿激素分泌不当综合征（SIADH）的发生率，并评估视神经脊髓炎（NMO）和NMO谱系障碍（NMOSD）患者中SIADH与下丘脑病变之间的关系。采用转染重组人AQP4的HEK-293细胞通过间接免疫荧光法检测AQP4抗体。对患者的临床资料进行回顾性分析。总共确诊了192例AQP4抗体阳性患者，其中41例患者（21.4%）纳入本研究。6例患者（14.6%，6/41）符合SIADH标准，其中1例患者低钠血症为轻度，5例为重度。5例患者出现意识模糊或意识减退。4例患者被诊断为NMO，2例被诊断为复发性视神经炎。磁共振成像显示41例患者中有11例（26.8%）存在下丘脑病变。所有SIADH患者均有下丘脑异常。所有患者经静脉注射甲泼尼龙和静脉注射免疫球蛋白治疗后低钠血症均得到缓解。SIADH在NMO/NMOSD患者中并不罕见，尤其是在有下丘脑附近病变的患者中。
