系统性红斑狼疮累及穹窿柱导致低钠血症1例  

Systemic lupus erythematosus involving the fornix column leading to hyponatremia: A case report

作　　者：柴静 王钥 穆荣 赵金霞[1] CHAI Jing;WANG Yue;MU Rong;ZHAO Jinxia(Department of Rheumatology,Peking University Third Hospital,Beijing 100191,China;Department of Lymphoma Internal Medicine,Peking University Cancer Hospital&Institute,Beijing 100142,China;Rare Disease Center,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院风湿免疫科,北京100191 [2]北京大学肿瘤医院暨北京市肿瘤防治研究所淋巴肿瘤内科,北京100142 [3]北京大学第三医院罕见病诊治中心,北京100191

出　　处：《北京大学学报（医学版）》2024年第6期1115-1118,共4页Journal of Peking University:Health Sciences

摘　　要：系统性红斑狼疮(systemic lupus erythematosus,SLE)是一种以全身多系统受累、多种自身抗体产生为主要特征的慢性自身免疫性疾病,如不及时治疗,会造成受累脏器的不可逆损害,最终导致患者死亡^([1])。其中,低钠血症是SLE的罕见并发症,若不及时处理,可危及患者生命,而其临床特点、病理机制尚不明确。本文报道1例重度低钠血症合并颅内穹窿柱病变的SLE患者,提示颅内血管炎可能是SLE合并低钠血症的原因之一。We reported the diagnostic and therapeutic process of a young male patient with systemic lupus erythematosus (SLE) who presented with severe hyponatremia as the main manifestation upon admission, and analyzed and discussed the case. The patient was a 19-year-old young male with a subacute course of disease, fever ≥38.3 ℃ that could not be explained by other causes, acute and subacute cutaneous lupus erythematosus, oral ulcers, arthritis, leukopenia (< 4×10 9/L), low C3+low C4, and positive anti-double-stranded DNA (anti-dsDNA). According to the 2019 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria, the score was 27 points. The patient was admitted to the hospital with SLE. After admission, further diagnosis of lupus was confirmed, excluding infection, tumor, endocrine disease, etc . Hyponatremia was the main complication of this lupus patient. Hyponatremia was a rare complication of lupus, only a few cases have been reported. In this study, the paient ’ s blood osmotic pressure was significantly reduced, which was considered to be hypotonic hyponatretic, urine osmotic pressure increased, maximum urine dilution caused by excessive water intake such as primary polydipsia, hypoosmotic fluid intake, and beer drinking were excluded, and 24 h urine volume and sodium were improved. The urinary sodium concentration was close to 20 mmol/L although with severe hyponatremia, considering the possibility of isovolemic hypotonic hyponatremia, the syndrome of improper secretion of antidiuretic hormone or adrenal cortical insufficiency. The patient had no manifestations, such as hypotension, typical site pigmentation, and high potassium, and there was little possibility of adrenal cortical insufficiency, and syndrome of inappropriate antidiuretic hormone secretion (SIADH) was considered for hyponatremia in the patient. The etiological mechanism of hyponatremia in lupus patients is not clear, but it is related to acute kidney injury, drugs and systemic inflammation. In

关 键 词：系统性红斑狼疮 低钠血症 狼疮血管炎 中枢神经系统 ADH分泌不当综合征 

分 类 号：R593.241[医药卫生—内科学]