Shimoda M, Yamada S, Yamamoto I, Tsugane R, Sato O
Department of Neurosurgery, Tokai University School of Medicine, Isehara, Japan.
Acta Neurochir (Wien). 1989;97(1-2):53-61. doi: 10.1007/BF01577740.
Measurement of plasma alpha-humanANP (ANP) and antidiuretic hormone (ADH) in 28 cases with aneurysmal subarachnoid haemorrhage (SAH) was carried out, and then compared with control subjects who were infused with hypertonic saline. In cases with hyponatremia (HN), statistical correlation between control subjects and cases without HN was not evident with regards to ANP and plasma osmolality (Posm), excreted fraction of filtrated sodium (FENa) and urinary Na/K. Furthermore, they secreted supernumerarilly in spite of HN. Cases with HN were further subdivided into two groups, they were those cases with negative total sodium balance at the time of appearance of HN, and those cases without total negative sodium balance. In the former, central venous pressure had a tendency to decrease, however, secretion of ANP and ADH was statistically not different in either groups. It appears that ANP regulated urinary sodium excretion against an osmotic or sodium load acts as a maintenance of homeostasis as an osmotic regulator. Cases with HN in which secretion of ADH was physiological, ANP secreted supernumerarilly in spite of hypoosmonaemia and hypovolaemia. Our findings may contribute to a better understanding of the pathophysiological processes leading to hyponatremia in cases with cerebral disorders, and may help to improve the treatment possibilities.
对28例动脉瘤性蛛网膜下腔出血（SAH）患者的血浆α-人心房钠尿肽（ANP）和抗利尿激素（ADH）进行了测定，然后与输注高渗盐水的对照受试者进行比较。在低钠血症（HN）患者中，对照受试者与无HN患者之间在ANP与血浆渗透压（Posm）、滤过钠排泄分数（FENa）和尿钠/钾方面的统计相关性不明显。此外，尽管存在HN，他们仍分泌过多。HN患者进一步分为两组，即出现HN时总钠平衡为负的患者和总钠平衡不为负的患者。在前者中，中心静脉压有下降趋势，然而，两组中ANP和ADH的分泌在统计学上没有差异。似乎ANP作为一种渗透调节剂，通过调节尿钠排泄以应对渗透或钠负荷，从而维持体内平衡。在ADH分泌正常的HN患者中，尽管存在低渗血症和低血容量，ANP仍分泌过多。我们的研究结果可能有助于更好地理解导致脑部疾病患者低钠血症的病理生理过程，并可能有助于改善治疗方案。
