68例第二代抗抑郁药物致抗利尿激素分泌不当综合征文献病例分析  

Analysis of 68 cases of second-generation antidepressants-induced syndrome of inappropriate antidiuretic hormone secretion reported in the literature

作　　者：陈洁 熊建华 Jie CHEN;Jian-Hua XIONG(Department of Pharmacy,Wenzhou People’s Hospital,Wenzhou 325000,Zhejiang Province,China)

机构地区：[1]温州市人民医院药剂科,浙江温州325000

出　　处：《药物流行病学杂志》2023年第2期207-212,共6页Chinese Journal of Pharmacoepidemiology

摘　　要：目的探究第二代抗抑郁药物相关抗利尿激素分泌不当综合征(SIADH)的特点,为临床安全用药提供参考。方法检索获得第二代抗抑郁药物引起SIADH的文献病例,对患者一般情况、合并疾病、第二代抗抑郁药物种类、联合用药、SIADH诱导时间、血钠水平、临∶床表现及转归等进行统计分析。结果筛选出有效文献60篇,病例68例,男女比例12.09,患者平均年龄(73.85±13.07)岁。使用选择性5-羟色胺再摄取抑制药(SSRIs)的病例最多,半数患者联用血管紧张素转化酶抑制药/血管紧张素Ⅱ受体拮抗药、利尿药、质子泵抑制药等药物。SIADH的诱导期为2~180 d,中位时间为10 d,其中59例(86.77%)在30 d内发生;诊断为SIADH时平均血钠为(116.59±7.57)mmol·L^(-1),中度低钠血症10例,重度低钠血症58例;临床表现为癫痫发作、恶心、虚弱无力、嗜睡、疼痛、昏迷、跌倒、呕吐等。诊断SIADH后停用相关药物,给予限制液体量、补盐等治疗,67例(98.52%)患者好转,平均好转时间为(6.20±4.87)d。结论临床需重视第二代抗抑郁药物引起的SIADH,加强对用药30 d内患者的随访,对出现SIADH相关症状患者及时诊断和治疗。Objective To explore the characteristics of second-generation antidepressants-induced syndrome of inappropriate antidiuretic hormone secretion(SIADH),so as to provide reference for the clinical safe drug use.Methods We searched literatures on the occurrence of SIADH associated with second-generation antidepressants,and the following information of patients including general information,comorbidities,types of secondgeneration antidepressants,combined drugs,induction time of SIADH,sodium levels,clinical manifestations and outcomes was statistically analyzed.Results A total of 68 patients(from 60articles)were collected,the male-female ratio was 1:2.09 and the average age was(73.85±13.07)years old.Most cases of SIADH were reported after the use of 5-selective serotonin reuptake inhibitors(SSRIs).Half of the patients were treated with angiotensin converting enzyme inhibitor(ACEI)/angiotensin Ⅱ receptor blockers(ARB),diuretics,proton pump inhibitors(PPI)and other drugs.The onset time of SIADH was 2-180 days after taking medication,with a median time of 10 days,of which 59 cases(86.77%)developed within 30 days;the average sodium levels in the diagnosis of SIADH was(116.59±7.57)mmol·L^(-1),including 10 cases of moderate hyponatremia and 58 cases of severe hyponatremia;the main SIADH symptoms included seizures,nausea,weakness,drowsiness,pain,coma,fall,vomiting,etc.Antidepressants was discontinued after diagnosis of SIADH,and symptomatic treatment was taken such as fluid restriction and hypertonic saline,67 patients(98.52%)recovered and the average improvement time was(6.20±4.87)days.Conclusions We should pay more attention to second-generation antidepressants-induced SIADH,and strengthen the follow-up for patients within 30 days of medication so as to timely diagnose and treat patients with SIADH-related symptoms.

关 键 词：第二代抗抑郁药 抗利尿激素分泌不当综合征 药品不良反应 病例报告 

分 类 号：R969[医药卫生—药理学]