Department II of Internal Medicine (Nephrology, Rheumatology, Diabetes, and General Internal Medicine) and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany.
Department for Experimental and Clinical Biomedical Sciences "Mario Serio," University of Florence, Italy.
Am J Med. 2020 Aug;133(8):986-993.e5. doi: 10.1016/j.amjmed.2019.12.056. Epub 2020 Mar 5.
The impact of chronic moderate and profound hyponatremia on neurocognitive performance, motor skills, and mood stability has not been investigated systematically so far, and results regarding mild to moderate hyponatremia are inconsistent. Furthermore, it is not known whether treatment has an effect on outcome in these patients.
A total of 130 hospitalized patients with confirmed euvolemic hyponatremia (<130 mEq/L) were subjected to a test battery (Mini-Mental State Examination, DemTect, Trail-Making Tests A and B, Beck Depression Inventory, Timed-up-and-go Test) before and after treatment; additionally, 50 normonatremic group-matched patients served as reference group.
The scores of all tested domains were significantly worse in the hyponatremia group (median serum sodium [Na] 122 (119-126) mEq/L) as compared to the reference group (P <0.001), and the odds of obtaining a pathological test result increased markedly with more profound hyponatremic states (odds ratios between 5.0 and 21.8 in the group with Na <120 mEq/L compared to reference group). Inversely, treatment led to a significant amelioration of all test results with medium to large effect sizes. Linear regression models revealed the increment of Na as an important predictor of test outcome.
We demonstrate a clear association between lower levels of Na beyond mild hyponatremia and impairment of neurocognitive and motor performance as well as mood disorders. Our analysis further suggests a causal role of hyponatremia in this context. However, there are apparent differences between the distinct tested domains warranting further investigations.
目前尚未系统研究慢性中重度低钠血症对神经认知功能、运动技能和情绪稳定性的影响，而关于轻中度低钠血症的结果也不一致。此外，目前尚不清楚这些患者的治疗是否会对结果产生影响。
共纳入 130 例确诊为等容性低钠血症（<130mEq/L）的住院患者，在治疗前后进行了一系列测试（简易精神状态检查、DemTect、连线测试 A 和 B、贝克抑郁量表、计时起立行走测试）；此外，还纳入了 50 例与低钠血症组相匹配的正常血钠组患者作为对照组。
与对照组相比，低钠血症组（血清钠中位数 [Na] 122（119-126）mEq/L）所有测试领域的得分均显著降低（P<0.001），且随着低钠血症程度的加重，获得病理性测试结果的几率明显增加（与对照组相比，Na<120mEq/L 组的比值比在 5.0 至 21.8 之间）。相反，治疗导致所有测试结果均显著改善，具有中到大量的效应量。线性回归模型表明，Na 的增加是测试结果的一个重要预测因子。
我们证明了 Na 水平低于轻度低钠血症与神经认知和运动功能以及情绪障碍的损害之间存在明显的相关性。我们的分析进一步表明，在这种情况下，低钠血症起着因果作用。然而，不同的测试领域之间存在明显的差异，需要进一步的研究。
