| Background and ObjectiveThe syndrome of inappropriate antidiuretic hormone secretion(SIADH)was discovered and named by Schwartz and Bartter in two bronchial lung cancer patients in 1957 [1].However,with the in-depth research,the study found that the AVP level in a small number of patients with SIADH was very low or even undetectable;in some patients,mutations in the AVP receptor resulted in urine concentration in the absence of AVP,so not all Patients with SIADH have elevated levels of circulating AVP,so this syndrome should be described more accurately with SIAD.The SIADH was changed to SIAD in the 2014 European hyponatraemia guidelines [2].Clinically SIAD onset is more occult,clinical manifestations lack specificity,and clinicians have relatively little knowledge of the disease,lack of attention,can easily lead to misdiagnosis,missed diagnosis;and the prognosis of this disease depends on the original cause and timing of treatment,if not Timely diagnosis and aggressive treatment can easily lead to serious consequences and even death.Therefore,full understanding of the clinical features of SIAD,timely diagnosis and active treatment is crucial.At present,there is still a lack of multi-center and large-sample studies on SIAD at home and abroad,and there are few retrospective studies on small samples.Now we have clinical studies on patients admitted to our hospital and diagnosed as having SIAD from January 2012 to November 2017.The data were retrospectively summarized and analyzed to strengthen the understanding of clinicians on the disease and to improve the diagnosis and treatment of the disease.MethodsTo retrospectively analyze the clinical data of patients diagnosed with SIAD at the First Affiliated Hospital of Zhengzhou University from January 2012 to November 2017,including the age of onset,gender,duration of disease,first symptoms,first examination department,laboratory examination,treatment Methods and effects.Sixty-two patients were divided into group A and group B according to the cause and whether there were tumors;according to whether the age was more than60 years old(the United Nations World Health Organization provides for the elderly over the age of 60),divided into groups C and D,their clinical characteristics and Laboratory indicators for comparative analysis.Results1.General data: A total of 62 SIAD patients were included in the study,including 40 males(64.5%),22 females(35.5%),male: female = 1.82:1,and average age:(62.15 ± 15.36)years old,including Patients over the age of 60 were 38 cases,accounting for 61.3%;duration of disease was 2 hours to 4 years(median of 2months).2.Primary cause and clinical manifestations: The primary cause of SIAD was central nervous system disease(24 cases,accounting for 38.7%)and benign pulmonary disease(16 cases,accounting for 25.8%),followed by malignant tumors.Disease(13 cases,21%).The follow-up of 7 patients with idiopathic SIAD in this study was performed.One case of primary disease was diagnosed as having been diagnosed with lung cancer for half a year.Most patients with SIAD had onset of digestive symptoms(37 cases,59.7%)and neuropsychiatric symptoms(13 cases,21%)caused by hyponatremia.3.Laboratory test indicators: Patients had the highest abnormal ratios of blood Na,blood Ca,blood Cl,HCT,UA,Sosm,Uosm,overall low calcium(2.16±0.15)mmol/l,low chlorine(86.08±7.96)mmol/l Low hematocrit(0.36 ± 0.40)L/L and hypouricemia(134.65 ± 63.92)umol/l.Comparison between group A and group B:group A had lower serum sodium(117.62±4.34)and lower plasma osmolality(258.21±17.16),with statistical significance(P<0.05);group C and group D In comparison,the plasma osmotic pressure was significantly lower in the elderly than in the young group,with a statistically significant difference(P<0.05).4.After treatment,the total serum sodium level in the 62 patients(136.34±6.51)mmol/L was significantly higher than before treatment(120.68±8.39)mmol/L,and the difference was statistically significant(P<0.05).Among them,56 cases were combined therapy(limited water,diuresis combined with hypertonic saline),4 cases were treated with doxycycline alone,and 2 cases were treated with tolvaptan alone.Conclusions1.The primary cause of SIAD is central nervous system disease and pulmonary infection;2.The clinical manifestations of patients with SIAD were mainly caused by hyponatremia,including digestive system symptoms and neuropsychiatric symptoms;3.In the symptomatic treatment,limited water,diuresis combined with hypertonic saline,the use of doxycycline alone or tolvaptan tablet has good curative effect on SIAD. |
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