Department of Neurology, The National University Hospital of Iceland, Reykjavik, Iceland.
Department of Neurology, Karolinska University Hospital, Stockholm, Sweden.
Acta Neurol Scand. 2019 Nov;140(5):342-349. doi: 10.1111/ane.13150. Epub 2019 Aug 19.
To report the incidence rate of osmotic demyelination syndrome (ODS), associated risk factors, treatment, and long-term outcomes in a nationwide cohort.
We conducted a retrospective study of individuals diagnosed with central pontine myelinolysis (ICD-10 code G37.2) in the Swedish National Patient Register during 1997-2011.
During the study period, we identified 83 individuals with ODS, 47 women and 36 men. Median age at diagnosis was 55 years. The incidence rate of ODS for the entire study period was 0.611 (95% CI: 0.490-0.754) per million person-years and increased during the study period from 0.271 (95% CI: 0.147-0.460) in 1997-2001 to 0.945 (95% CI: 0.677-1.234) individuals per million person-years in 2007-2011. Most cases (86.7%) were hyponatremic with a median sodium level at admission of 104 mmol/L. All hyponatremic cases were chronic. The cause of hyponatremia was multifactorial, including drugs (56.9%), polydipsia (31.9%), and vomiting or diarrhea (41.7%). A majority of patients (69.9%) were alcoholics. Hyponatremic patients were predominantly treated with isotonic saline (93.1%) and only 4.2% with hypotonic fluids. The median correction rate was 0.72 mmol/L/h. Only six patients were corrected in accordance with national guidelines (≤8 mmol/L/24/h). At three months, 7.2% had died and 60.2% were functionally independent (modified Rankin Scale 0-2).
We found an increasing incidence during the study period, which could partly be explained by increased access to magnetic resonance imaging. ODS occurs predominantly in patients with extreme chronic hyponatremia which is corrected too fast with isotonic saline. Most patients survived and became functionally independent.
报告全国队列中渗透压性脱髓鞘综合征（ODS）的发病率、相关危险因素、治疗和长期结局。
我们对瑞典国家患者登记处 1997-2011 年间诊断为脑桥中央髓鞘溶解症（ICD-10 编码 G37.2）的个体进行了回顾性研究。
在研究期间，我们共发现 83 例 ODS 患者，其中 47 例为女性，36 例为男性。诊断时的中位年龄为 55 岁。整个研究期间，ODS 的发病率为每百万人年 0.611（95%CI：0.490-0.754），研究期间发病率从 1997-2001 年的 0.271（95%CI：0.147-0.460）增加到 2007-2011 年的 0.945（95%CI：0.677-1.234）。大多数病例（86.7%）为低钠血症，入院时中位钠水平为 104mmol/L。所有低钠血症患者均为慢性患者。低钠血症的病因是多因素的，包括药物（56.9%）、多饮（31.9%）和呕吐或腹泻（41.7%）。大多数患者（69.9%）为酗酒者。低钠血症患者主要接受等渗盐水治疗（93.1%），仅 4.2%接受低渗液治疗。中位纠正率为 0.72mmol/L/h。仅 6 例患者符合国家指南（≤8mmol/L/24/h）。在三个月时，7.2%的患者死亡，60.2%的患者功能独立（改良 Rankin 量表 0-2）。
我们发现研究期间发病率呈上升趋势，这在一定程度上可归因于磁共振成像的普及。ODS 主要发生在极端慢性低钠血症的患者中，这些患者的低钠血症过快地用等渗盐水纠正。大多数患者存活并恢复功能独立性。
