1例丙戊酸钠致儿童抗利尿激素分泌失调综合征报道并文献复习  

A Case of Syndrome of Inappropriate Antidiuretic Hormone Secretion Induced by Sodium Valproate and Literature Review

作　　者：程义 王永霞 高铭 马秀伟 Cheng Yi;Wang Yongxia;Gao Ming;Ma Xiuwei(The Seventh Medical Center of PLA General Hospital,Beijing100700,China;Renhuai People’s Hospital,Guizhou Zunyi 564500,China)

机构地区：[1]解放军总医院第七医学中心,北京100700 [2]仁怀市人民医院,贵州遵义564500

出　　处：《儿科药学杂志》2023年第7期10-13,共4页Journal of Pediatric Pharmacy

基　　金：吴阶平医学基金会临床科研专项资助基金,编号320.6750.2020-06-59。

摘　　要：目的:探讨儿童长期服用丙戊酸钠(VPA)导致抗利尿激素分泌失调综合征(SIADH)的发病机制、诊疗经过,提高临床医师认识水平。方法:总结1例TBC1D24基因突变相关癫痫儿童长期服用VPA导致SIADH的临床资料,并以“丙戊酸钠”和“抗利尿激素分泌失调综合征”为关键词在中国知网和PubMed数据库中进行文献检索和分析。结果:该患儿12岁,因TBC1D24基因突变相关癫痫长期服用VPA,因癫痫发作伴意识障碍入院,住院后期发现重度低钠血症,积极补充3%氯化钠、限液、利尿等对症治疗后血钠水平未恢复正常,将VPA减量后血钠水平恢复正常,排除可能引起低钠血症的其他病因后确诊为VPA致SIADH,多次门诊随访监测显示血钠水平正常。检索数据库后共收集7篇相关病例报道,减停VPA后10例成人患者均血钠水平恢复正常。结论:儿童长期服用VPA出现顽固性低钠血症时,需考虑VPA致SIADH,及时调整治疗方案,避免出现严重的不良事件。Objective:To probe into the pathogenesis,diagnosis and treatment process of syndrome of inappropriate antidiuretic hormone secretion(SIADH)induced by long-term use of sodium valproate(VPA)in children,so as to improve the awareness of clinicians.Methods:Clinical data of SIADH induced by long-term use of VPA in a child with TBC1D24 gene mutation-related epilepsy were summarized.“Sodium valproate”and“syndrome of inappropriate antidiuretic hormone secretion”were used as keywords to perform literature search and analysis in CNKI and PubMed databases.Results:The 12-year-old child took VPA for TBC1D24 gene mutation-related epilepsy for a long time,and was admitted into the hospital for epilepsy accompanied by consciousness disorder.Severe hyponatremia was found in the later stage of hospitalization,and the blood sodium level did not return to normal state after symptomatic treatment such as 3%sodium chloride,fluid restriction,and diuresis.The serum sodium level returned to normal state after VPA dose reduction.After excluding other causes that may induce hyponatremia,the diagnosis of SIADH induced by VPA was confirmed.Multiple outpatient follow-up monitoring showed that the serum sodium level was normal.A total of 7 related case reports were collected after searching the databases,and serum sodium levels returned to normal state after VPA was reduced in 10 adult patients.Conclusion:When children develop refractory hyponatremia after long-term use of VPA,SIADH induced by VPA should be considered,and the treatment regimen should be adjusted in time to avoid severe adverse events.

关 键 词：丙戊酸钠 儿童 抗利尿激素分泌失调综合征 低钠血症 

分 类 号：R969.3[医药卫生—药理学]