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支气管肺类癌所致抗利尿激素分泌不适当综合征 附一例报道 |
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朱慧娟 史轶蘩 邢小平 邓洁英 金自孟 曾正陪 李泽坚 戈峰 陈杰
【摘要】 目的 为了提高对罕见病例的诊断水平，本文分析了支气管肺类癌致抗利尿激素分泌不适当综合症(SIADH)的临床和病理特点。方法 讨论一例患者的诊断过程及术中分别抽取进入肿瘤的动、静脉血查ADH水平，结果明显高于正常，术后病理诊断为支气管肺非典型类癌，使用多克隆ADH抗体对肿瘤组织行免疫组织化学染色阳性。结果 支气管肺非典型类癌异位分泌ADH导致SIADH。结论 支气管肺非典型类癌是不同于燕麦细胞癌等的另一种能导致SIADH的肺部肿瘤。
【关键词】 非典型类癌 抗利尿激素分泌不适当综合征
The syndrome of inappropriate antidiuretic hormone secretion caused by bronchopulmonary atypical carcinoid (report of one case)
ZHU Huijuan,SHI Yifan,XING Xiaoping,et al.Department of Endocrinology,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing,100730
【Abstract】 Objective To study the clinical and pathological characters of the syndrome of inappropriate secretion of the antidiuretic hormone (SIADH) caused by bronchopulmonary atypical carcinoid. Methods To analyze the process of diagnosis. We took the blood of the vein and artery which supplied the mass separately. The ADH levels of blood were higher than normal and the ADH in the vein was ten times more than that of the artery (they were 20.37pg/ml and 195.57pg/ml, respectively, normal value≤14pg/ml). The tissue of the tumor was positively stained by antibody of ADH immunohistochemically. The pathology of the mass was atypical carcinoid without local metastases. Results The cause of this SIADH patients was ectopic secretion of ADH by the carcinoid. Conclusion Bronchopulmonary atypical carcinoid is another rare kind of tumor which can induce SIADH.
【Key words】 Atypical carcinoid Syndrome of inappropriate secretion of the antidiuretic hormone
(Chin J Endocrinol Metab, 1999,15:104-107)
1938年，Wilkler与Crankshaw首次提及低钠血症与肺癌的关系。继之Schwartz和Batter提出了抗利尿激素分泌不适当综合征(SIADH)这一综合征的名称〔1〕。SIADH是由于ADH的不适当分泌，通过刺激集合管ADH的V2受体，导致水分滞留，引起低钠血症，血渗透压下降，尿钠及尿渗透压增高，而出现的一系列临床症状。
复习近十年有关文献。引起SIADH病因中除了肺部疾患通过容量和压力感受器刺激下丘脑分泌ADH〔3-5〕，以及中枢神经系统疾患直接刺激神经元分泌ADH或破坏下丘脑神经垂体细胞膜的通透性导致SIADH〔2〕外，还有细胞[1] [2] 下一页
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