Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
Int J Tuberc Lung Dis. 2018 Apr 1;22(4):452-457. doi: 10.5588/ijtld.17.0479.
To report atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) levels in patients with tuberculous meningitis (TBM) and acute encephalitis syndrome (AES), and evaluate their relationship with hyponatraemia.
Consecutive patients with TBM and AES were included in the study. Hyponatraemia was categorised as cerebral salt wasting (CSW), syndrome of inappropriate secretion of antidiuretic hormone (SIADH) and a miscellaneous group based on clinical and laboratory criteria. Serum ANP and BNP levels were measured upon hospital admission, at the time of diagnosis of hyponatraemia and upon correction of hyponatraemia. Outcome at 3 months was assessed using the modified Rankin scale (mRS) as good (mRS 2) and poor (mRS >2).
There were 67 patients with TBM and 77 with AES. Hyponatraemia was more common in TBM than in AES (65.7% vs. 27%, P < 0.01). Forty-one (63.1%) patients had CSW, 6 (9.2%) SIADH and 18 (27.7%) had miscellaneous causes of hyponatraemia. During hyponatraemia, ANP (180 ± 45 vs. 106 ± 32 pg/ml, P < 0.01) and BNP (263 ± 118 vs. 163 ± 91 pg/ml, P 0.01) levels were significantly increased compared with baseline, and remained high even after Na+ correction.
ANP and BNP levels were increased during hyponatraemia and remained high even after correction of hyponatraemia in TBM and AES, especially in patients with CSW. However, ANP and BNP levels could not be used to differentiate CSW from SIADH.
报告结核性脑膜炎（TBM）和急性脑炎综合征（AES）患者心房利钠肽（ANP）和脑利钠肽（BNP）水平，并评估其与低钠血症的关系。
本研究纳入了连续的 TBM 和 AES 患者。根据临床和实验室标准，低钠血症分为脑性盐耗综合征（CSW）、抗利尿激素不适当分泌综合征（SIADH）和混合组。入院时、低钠血症诊断时和低钠血症纠正时测量血清 ANP 和 BNP 水平。3 个月时采用改良 Rankin 量表（mRS）评估预后，mRS 评分 2 为良好（mRS 评分 2），mRS 评分 >2 为不良。
TBM 患者 67 例，AES 患者 77 例。TBM 患者低钠血症发生率高于 AES（65.7%比 27%，P < 0.01）。41 例（63.1%）为 CSW，6 例（9.2%）为 SIADH，18 例（27.7%）为低钠血症的其他原因。低钠血症时，ANP（180 ± 45 比 106 ± 32 pg/ml，P < 0.01）和 BNP（263 ± 118 比 163 ± 91 pg/ml，P 0.01）水平明显升高，即使在纠正低钠血症后仍保持高水平。
TBM 和 AES 患者低钠血症时 ANP 和 BNP 水平升高，即使在纠正低钠血症后仍保持高水平，尤其是 CSW 患者。然而，ANP 和 BNP 水平不能用于区分 CSW 和 SIADH。
