结核性脑膜炎患者的血浆精氨酸加压素与抗利尿激素分泌不当综合征

Plasma arginine vasopressin and the syndrome of inappropriate antidiuretic hormone secretion in tuberculous meningitis.

作者信息

Cotton M F, Donald P R, Schoeman J F, Aalbers C, Van Zyl L E, Lombard C

机构信息

Department of Pediatrics and Child Health, University of Stellenbosch, Republic of South Africa.

出版信息

Pediatr Infect Dis J. 1991 Nov;10(11):837-42. doi: 10.1097/00006454-199111000-00009.

DOI:10.1097/00006454-199111000-00009

PMID:1844394

Abstract

Biochemical evidence of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) was documented in 17 of 24 (71%) children with tuberculous meningitis. Plasma arginine vasopressin concentrations in patients with signs of SIADH were significantly higher (median, 15.44 (range, 1.62 to greater than 24.52) pg/ml; n = 14) than those without (median, 1.91 (range, 0.44 to 4.91) pg/ml; n = 6) (P less than 0.002). Patients who developed evidence of SIADH were older than those who did not (median, 34 (range, 6 to 101) months vs. 10 (range, 6 to 38) months; P less than 0.007). Five patients with and none without died. In 9 patients evidence of SIADH developed only after hospitalization. These patients received a median of 58 (range, 28 to 109) ml/kg/day fluids (n = 7) before developing evidence of SIADH compared with 107 (range, 58 to 146) ml/kg/day received by patients who did not develop SIADH (n = 6) (P = 0.035). SIADH occurs commonly and its presence appears to influence the outcome of tuberculous meningitis in children.

摘要

24名结核性脑膜炎患儿中有17名（71%）记录到抗利尿激素分泌异常综合征（SIADH）的生化证据。出现SIADH体征的患者血浆精氨酸加压素浓度显著高于未出现的患者（中位数，15.44（范围，1.62至大于24.52）pg/ml；n = 14）（中位数，1.91（范围，0.44至4.91）pg/ml；n = 6）（P<0.002）。出现SIADH证据的患者比未出现的患者年龄大（中位数，34（范围，6至101）个月对10（范围，6至38）个月；P<0.007）。5名出现SIADH的患者死亡，未出现的患者无死亡。9名患者的SIADH证据仅在住院后出现。这些患者在出现SIADH证据之前接受的液体量中位数为58（范围，28至109）ml/kg/天（n = 7），而未出现SIADH的患者接受的液体量为107（范围，58至146）ml/kg/天（n = 6）（P = 0.035）。SIADH在儿童结核性脑膜炎中常见，其出现似乎会影响疾病转归。