结核性脑膜炎伴低钠血症的临床特征分析

Clinical characteristics in tuberculous meningitis with hyponatremia

摘要:

目的：在结核性脑膜炎（tuberculous meningitis，TBM）患者中，探讨低钠血症的患病情况及临床特征。方法：纳入2014年1月至2016年10月于重庆医科大学附属第一医院诊断的TBM患者115名，收集受试者病史、一般情况以及实验室检查结果，计算TBM中低钠血症发生率，比较伴有低钠血症和不伴低钠血症2组患者的临床特点。结果：TBM患者伴低钠血症的比例为70.4%。与不伴低钠血症的TBM患者相比，伴低钠血症TBM患者除血钠和血浆渗透压较低以外，血肌酐水平[54.5（45.2，68.0） μmmol/L vs. 64.0（54.5，75.7） μmmol/L，P=0.004]、血尿酸水平[164.0（123.5，218.2） μmmol/L vs. 229.5（178.5，327.0） μmmol/L，P<0.001]，以及脑脊液含糖量[2.0（1.7，3.0） mmol/L vs. 3.0（2.0，4.0） mmol/L，P=0.002]、脑脊液含氯量[112.0（104.0，116.0） mmol/L vs. 120.0（116.2，125.7） mmol/L，P<0.001]亦较低；而入院体温[（37.4±1.0） ℃ vs. （36.7±0.7） ℃，P=0.002]、脑脊液蛋白量[2.0（1.2，3.0） g/L vs. 1.0（0.8，2.1） g/L，P=0.003] 较高；2组年龄、性别等无明显差别。进一步分析TBM伴低钠血症的原因后发现，该类患者有65.4%为抗利尿激素分泌失调综合征（syndrome of inappropriate antidiuretic hormone secretion，SIADH）。与非SIADH引起的低钠血症相比，SIADH型低钠血症患者的血浆渗透压、血钠、血尿酸、脑脊液含氯量更低，脑脊液压力更高。TBM患者中SIADH漏诊率高达90.6%。结论：TBM患者低钠血症发生率高，SIADH是TBM伴发低钠血症的重要原因。

Abstract:

Objective：To explore the prevalence and clinical features of hyponatremia in tuberculous meningitis（TBM）. Methods：One hundred and fifteen patients diagnosed with TBM in the hospital from January 2014 to October 2016 were enrolled. General information and clinical data were collected. Clinical features of TBM with and without hyponatremia were compared.Occurence of hyponatremia in TBM was calculated.Clinical features of patients with and without hyponatremia were compared. Results：In our study，70.4% patients were with hyponatremia. Compared with normonatremic counterparts，besides lower serum sodium and plasma osmotic pressure，pa－tients with hyponatremia also tended to have lower serum creatinine[54.5（45.2，68.0） μmmol/L vs. 64.0（54.5，75.7） μmmol/L，P=0.004]，blood uric acid[164.0（123.5，218.2） μmmol/L vs. 229.5（178.5，327.0） μmmol/L，P<0.001]，glucose[2.0（1.7，3.0） mmol/L vs. 3.0（2.0，4.0） mmol/L，P=0.002] and chloride content[112.0（104.0，116.0） mmol/L vs.120.0（116.2，125.7） mmol/L，P<0.001] in cerebrospinal fluid. Both temperature[（37.4±1.0）℃ vs. （36.7±0.7） ℃，P=0.002] and protein content in cerebrospinal fluid[2.0（1.2，3.0） g/L vs. 1.0（0.8，2.1） g/L，P=0.003] were higher in the hyponatremic patients. There was no significant difference in gender and age between this two groups. According to the analysis of the reason for TBM with hyponatremia，65.4% patients with syndrome of inappropriate antidiuretic hormone secretion（SIADH）. Compared with the patients with hyponatremia for other reason，patients with SIADH had lower serum sodium，plasma osmotic pressure，blood uric acid，chloride content in cerebrospinal fluid，while the cerebrospinal fluid pressure was higher. In patients with SIADH，as high as 90.6% of them missed the diagnosis. Conclusion：According to this study，the incidence of TBM with hyponatremia is high. SIADH is an important cause of TBM with hyponatremia.