摘要
目的了解大剂量环磷酰胺(HD-CTX)对儿童水、电解质及肾功能的影响,探讨低钠血症的发生机制。方法观察HD-CTX治疗后患儿的临床反应,并监测治疗前及开始后6h或8h血生化、肌酸酐(Cr),部分患儿测定治疗前后血管升压素(ADH),对比分析HD-CTX治疗前后检测结果。结果108例中呕吐24例,少尿22例,水肿4例,7例有神经肌肉症状,5例有腹痛、腹泻等。HD-CTX后血钠明显下降[6h:(139.12±3.30)mmol/Lvs(134.06±8.23)mmol/L,8h:(141.77±3.59)mmol/Lvs(133.26±6.41)mmol/LPa<0.05],39例出现低钠血症,其中12例为严重低钠(<125mmol/L);血渗透压与血钠下降平行;监测用药后8h患儿血钠、渗透压下降较6h明显。血钠下降幅度与患儿年龄无关,伴呕吐或少尿者血钠降低较无相应症状者明显。HD-CTX治疗前后血ADH无显著变化[(0.178±0.129)μg/Lvs(0.194±0.173)μg/LP>0.05),与血钠及渗透压也无相关性。HD-CTX治疗后8h血Cr明显高于用药前[(29.95±13.61)μmol/Lvs(43.33±17.25)μmol/LP<0.05],且增加倍数与年龄负相关(r=-0.320P<0.05);对照组化疗患儿,化疗水化后血Cr显著低于化疗前[(32.64±14.29)μmol/Lvs(49.72±12.52)μmol/LP<0.05]。结论HD-CTX治疗可引起严重低钠血症,伴呕吐或尿量减少患儿更应注意。低钠发生的机制主要为水潴留所致,可能与ADH的不恰当分泌无关。HD-CTX还可导致血Cr升高,尤其在小年龄患儿更明显,可能对肾小球滤过功能有影响。
Objective To learn about electrolytes imbalance and water intoxication in children treated with high - dose cyclophosphamide （ HD - CTX） as well as the renal function and the relative clinical symptoms, and study the mechanisms of hyponatremia. Methods Patients＇ clinical manifestations during and after HD - CTX therapy were summarized. Serum electrolytes and creatinine（Cr） were detected before and 6 or 8 hours after therapy with HD - CTX, antidiuretic hormone （ADH） in some patients were measured. Results Of 108 therapeutic cases 24 accompanied with vomits and 22 with a decreased urine output,in which 4 developed eyelid or ankle edema. Seven cases had neural - sarcous symptoms and 5 cases had abdominal pain or diarrhea. Serum sodium decreased significantly after HD - CTX [ （ 139. 12 ±3.30） mmol/L vs （ 134.06 ± 8.23） mmol/L] in whom rechecked after 6 h, （ 141.77±3.59） mmol/L vs （ 133.26± 6.41 ） mmol/L in those rechecked after 8 h （ Pa 〈 0.05 ） , paralleled to osmotic pressure. Thirty - nine developed hyponatremia, serum sodium 〈 125 mmol/L with marked symptoms were recorded in 12 cases. The decrease of serum sodium was not relative to age, but more significant in those with vomits or oliguria. There was no change in serum ADH before and after HD -CTX[ （0. 178 ± 0. 129） μg/L vs （0. 194 ± 0. 173） μg/L P 〉 0.05 ]. SerumCrincreased8 h after therapy [ （ 29. 95 ±13 . 61） μmol/Lvs （43.33 ± 17.25） μmol/L P 〈 0. 05 ] , and the times of increase inversely correlated to age（ r = - 0. 320 P 〈 0.05 ）. As a comparison serum Cr decreased after profuse rehydration[ （49.72 ± 12.52） p.mol/L vs （32.64 ± 14.29） p.mol/L P 〈 0.05 ] in high - dose methotrexate chemotherapy in children. Conclusions HD - CTX may cause severe hyponatremia in children especially in those accompany with vomit and decreased urine output, the mechanism of which mainly lies in water retention without increased ADH secretion. It seems to cause a decreased glomerular filtration
出处
《实用儿科临床杂志》
CAS
CSCD
北大核心
2008年第3期208-210,共3页
Journal of Applied Clinical Pediatrics
关键词
环磷酰胺
电解质
低钠血症
血管升压素
肾功能
肌酸酐
cyclophosphamide
electrolyte
hyponatremia
antidiuretic hormone
renal function
creatinine
