长期治疗抗利尿激素分泌不当综合征（SIADH）时轻度限水加或不加尿素与单纯限水的比较：尿渗透压有助于选择吗？

Mild water restriction with or without urea for the longterm treatment of syndrome of inappropriate antidiuretic hormone secretion (SIADH): Can urine osmolality help the choice?

机构信息

Department of Internal Medicine, Cliniques Universitaires Erasme, Brussels, Belgium; Research Unit on Hydromineral Metabolism, Cliniques Universitaires Erasme, Brussels, Belgium.

Research Unit on Hydromineral Metabolism, Cliniques Universitaires Erasme, Brussels, Belgium.

出版信息

Eur J Intern Med. 2018 Feb;48:89-93. doi: 10.1016/j.ejim.2017.09.024. Epub 2017 Oct 7.

DOI:10.1016/j.ejim.2017.09.024

PMID:29017746

Abstract

BACKGROUND

Treatment options for chronic SIADH include water restriction (WR) and urea. The usefulness of urine osmolality to guide the choice of the treatment option is not clearly defined. We hypothesized that urine osmolality can indicate whether treatment with mild water restriction alone could be successful.

METHODS

Retrospective Review of clinical and biochemical (blood and urine) data of patients with chronic SIADH treated for at least one year with mild WR (1.5-2l/day) either with or without urea.

RESULTS

Twenty nine patients were included. Nine patients were treated by mild WR. Mean serum sodium (SNa) and mean Uosm were 129±2mEq/l and 274±78mOsm/kgH2O respectively before WR, and increased to 138.5±3mEq/l and 505±87mOsm/kgHO (P<0.001). Eight patients were treated with mild WR and 15g urea daily, the SNa and Uosm before treatment were 127.5±3mEq/l and 340±100mOsm/kgHO respectively and increased to 136.5±1mEq/l and 490±151mOsm/kgHO (P<0.001). Four of the eight patients had a permanent low solute intake which contributed to hyponatremia. Twelve patients needed 30g urea daily combined with mild WR. The SNa and Uosm were respectively 126±2mEq/l and 595±176mOsm/kgHO and increased to 136.5±2mEq/l and 698±157mOsm/kgHO (P<0.05). Uosm increased in most of the treated patients.

CONCLUSIONS

About 30% of patients could be treated by moderate WR alone. All these patients presented an initial urine osmolality lower than 400mOsm/kgHO.

摘要

背景

慢性抗利尿激素分泌不当综合征（SIADH）的治疗选择包括限制水摄入（WR）和尿素。尿液渗透压是否能指导治疗选择尚不清楚。我们假设尿液渗透压可以表明轻度 WR 单独治疗是否可能成功。

方法

回顾性分析至少接受一年轻度 WR（1.5-2L/天）治疗的慢性 SIADH 患者的临床和生化（血液和尿液）数据，这些患者或单独使用 WR 或联合使用 WR 和尿素治疗。

结果

共纳入 29 例患者。9 例患者接受轻度 WR 治疗。WR 前平均血清钠（SNa）和平均尿渗透压（Uosm）分别为 129±2mEq/L 和 274±78mOsm/kgH2O，治疗后分别增加至 138.5±3mEq/L 和 505±87mOsm/kgHO（P<0.001）。8 例患者接受轻度 WR 和 15g 尿素每日治疗，治疗前 SNa 和 Uosm 分别为 127.5±3mEq/L 和 340±100mOsm/kgHO，治疗后分别增加至 136.5±1mEq/L 和 490±151mOsm/kgHO（P<0.001）。这 8 例患者中有 4 例因低溶质摄入而持续出现低钠血症。12 例患者需要每日 30g 尿素联合轻度 WR 治疗。SNa 和 Uosm 分别为 126±2mEq/L 和 595±176mOsm/kgHO，治疗后分别增加至 136.5±2mEq/L和 698±157mOsm/kgHO（P<0.05）。大多数接受治疗的患者 Uosm 均升高。