以抗利尿激素分泌不當為初發症狀之Guillain-Barre症候群

Inappropriate Secretion of Antidiuretic Hormone as an Initial Phenomenon of Guillain－Barre Syndrome

抗利尿激素分泌不當症狀群(Syndrome of Inappropriate Secretion of Antidiuretic Hormone，SIADH)不是Guillain-Barre 症候群(Guillain-Barre syndrome，GBS)之常見併發症。大部份GBS合併SIADH之個案，多與呼吸器使用或自律神經受損有關。且SIADH極少發生於GBS之前一週內。在此報告一例73歲男性，因4天來進行性四肢無力及未稍麻木而入院。在生化檢查中，血鈉濃度121 mEq/L，血滲透壓260 mosm/kg，尿鈉濃度155 mEq/L，尿滲透壓716 mosm/kg，遂診斷為SIADH。住院3天後，出現急性呼吸衰竭。之後施以每2天一次，連續5次之血漿分離療法。在第2次血漿分離術之後，即順利拔除氣管內管，自行呼吸；並在發病一個月後順利步行出院。住院過程中，除呼吸衰竭時出現盜汗及血循狀態不穩外，未見其他自律神經受損之症候。因此我們認為SIADH可以是GBS之初發症狀，呼吸器使用及自律神經損傷不是造成SIADH之主要原因。此類合併SIADH之GBS病人，對血漿分離療法仍有相當好之反應。

The syndrome of inappropriate secretion of antidiuretic hormone(SIADH)is not a common complication of Guillain-Barre syndrome (GBS). Most cases of SIADH in patients with GBS are associated with ventilator usage and autonomic involvement. Onset of SIADH rarely occurs in the first week of GBS. We report a case of GBS with early onset of SIADH. A 73-year-old man was admitted to our hospital following 4 days of progressive numbness and weakness in all four limbs. SIADH was suspected on the basis of low serum sodium concentration (121 mEq/L) and osmolality (260 mosm/kg) as well as high urine sodium concentration (155 mEq/L) and osmolality (716 mosm/kg). Three days after admission, respiratory failure developed and was treated by mechanical ventilation. Double filtration plasmapheresis was performed on alternate days for 5 sessions. The patient was successfully extubated after the second session of plasmapheresis. He was discharged one month later in ambulatory status. During hospitalization, no definite autonomic involvement could be found with the exception of transient unstable hemodynamic status and perspiration at the onset of respiratory failure. We conclude that SIADH can be an early phenomenon of GBS. Ventilator usage and autonomic involvement were not the major determinants for the development of SIADH in our patient. Patients with GBS complicated with SIADH may still have favorable outcome if managed with plasmapheresis.