度洛西汀相关抗利尿激素分泌不当综合征临床及文献病例分析  

Clinical and literature case analysis on duloxetine-related syndrome of inappropriate antidiuretic hormone secretion

作　　者：蔡俊[1] 陈洁 高蕾 胡云 李曼[3] Cai Jun;Chen Jie;Gao Lei;Hu Yun;Li Man(Office of Party&Administration Council,Nanjing Drum Tower Hospital Affiliated to Medical College of Nanjing University,Nanjing 210008,China;Department of Pharmacy,Wenzhou People′s Hospital,Zhejiang Province,Wenzhou 325099,China;Department of Geriatrics,Nanjing Drum Tower Hospital Affiliated to Medical College of Nanjing University,Nanjing 210008,China)

机构地区：[1]南京大学医学院附属鼓楼医院党政办公室,南京210008 [2]温州市人民医院药剂科,温州325099 [3]南京大学医学院附属鼓楼医院老年科,南京210008

出　　处：《药物不良反应杂志》2022年第12期633-640,共8页Adverse Drug Reactions Journal

基　　金：南京大学医院管理研究所医院管理课题(NDYG2020039)。

摘　　要：目的探讨度洛西汀相关抗利尿激素分泌不当综合征(SIADH)的临床特点。方法报道南京大学医学院附属鼓楼医院收治的1例度洛西汀相关SIADH的诊治经过,并对该例以及检索PubMed和Embase数据库(截至2021年12月31日)收集到的相关病例的主要临床资料(性别、年龄、罹患疾病情况、度洛西汀应用情况、联合用药情况、SIADH发生情况及干预与转归等),进行描述性统计分析。结果纳入分析的患者共27例,男性6例,女性21例;年龄38~92岁,中位年龄74岁;度洛西汀日剂量为20、30、40、60 mg和不详者者分别为5、9、1、10和2例,日剂量30 mg者中1例在一次性过量服用450 mg后发生SIADH。16例患者联用了有导致低钠血症风险或与度洛西汀有相互作用的药物,其中联用1、2、3、4种药物者分别为6、2、6、2例。开始服用度洛西汀至发生SIADH的时间除1例过量服用者为服药后1 h外,余26例为用药2 d~36个月,中位时间3 d,其中21例发生在7 d内。SIADH的主要临床表现包括神经系统症状(头痛、头晕、嗜睡等,20例)、消化系统症状(恶心、呕吐、食欲不振等,15例)和全身症状(疲劳、肢体无力等,6例)等。诊断SIADH时27例患者血钠水平为98~132 mmol/L,中位数117 mmol/L。SIADH严重程度为1、3、4级者分别为1例(3.7%)、7例(25.9%)和19例(70.4%)。在诊断或怀疑为度洛西汀相关SIADH后,所有患者均停用度洛西汀、限制液体入量并给予补钠治疗,5例患者应用了呋塞米,血钠水平在2~15 d内恢复正常,中位恢复时间为5 d。结论度洛西汀相关SIADH多发生于开始用药后7 d内,程度多较严重。停用度洛西汀并限制液体入量、给予补钠治疗,视病情给予利尿剂,患者预后良好。Objective To explore the clinical characteristics of syndrome of inappropriate antidiu-retic hormone secretion(SIADH)induced by duloxetine.Methods The diagnosis and treatment of a patient with duloxetine-related SIADH who was admitted to Nanjing Drum Tower Hospital Affiliated to Medical College of Nanjing University was reported,and the main clinical data(gender,age,prevalent diseases,use of duloxetine,combined medication,occurrence of SIADH,and intervention and outcome)of the case and related cases collected from the PubMed and Embase databases(up to December 31,2021)were analyzed by descriptive statistics.Results A total of 27 patients were included in the analysis,including 6 males and 21 females,aged from 38 to 92 years with a median age of 74 years.duloxetine with daily dose of 20,30,40,60-mg and unknown dose were in 5,9,1,10 and 2 patients,respectively,and one patient with daily dose of 30-mg developed SIADH after a single overdose of 450-mg.Sixteen patients were treated with drugs that may cause hyponatremia or interact with duloxetine.Among them,6,2,6,and 2 patients were treated with 1,2,3,and 4 drugs,respectively.The time from the beginning of duloxetine administration to the occurrence of SIADH,was 2 days to 36 months in 26 patients,with a median time of 3 days,except that one patient of overdose was 1 hour after administration,among which 21 patients occurred within 7 days.The main clinical manifestations of SIADH included nervous system symptoms(headache,dizziness,drowsiness,etc.in 20 patients),digestive system symptoms(nausea,vomiting,anorexia,etc.in 15 patients),and systemic symptoms(fatigue,limb weakness,etc.in 6 patients).When SIADH was diagnosed,the serum sodium level of the 27 patients was 98 to 132-mmol/L,with a median level of 117-mmol/L.The severity of SIADH with grade 1,3,and 4 was in 1(3.7%),7(25.9%),and 19(70.4%)patients,respectively.After the diagnosis or suspicion of duloxetine-related SIADH,duloxetine was discontinued in all patients,fluid intake was restricted and sodium supplement was

关 键 词：盐酸度洛西汀 ADH分泌不当综合征 低钠血症 病例报告 

分 类 号：R591.1[医药卫生—内科学]