结核性脑膜炎是否与交感神经失调有关？
Is cerebral salt wasting related to sympathetic dysregulation in tuberculous meningitis?
机构信息
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India; Department of Respiratory Medicine, King George's Medical University, Lucknow, India.
Analytical Chemistry Laboratory, Regulatory Toxicology Group, CSIR-Indian Institute of Toxicology Research (CSIR-IITR), Lucknow, India; Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, 201002, India.
出版信息
Neurosci Lett. 2021 Mar 16;747:135671. doi: 10.1016/j.neulet.2021.135671. Epub 2021 Jan 29.
BACKGROUND
Cerebral Salt wasting (CSW) is common in Tuberculous Meningitis (TBM) and is suggested to be due to sympathetic dysregulation of renal blood supply but has not been proven.
OBJECTIVE
To evaluate plasma Catecholamines in TBM patients with CSW and correlate with the markers of stress.
MATERIALS AND METHODS
The diagnosis of TBM was based on clinical, CSF and MRI criteria. Catecholamines level was measured by LC-MS on admission, at the time of hyponatremia and on correction of hyponatremia. Catecholamine levels were correlated with clinical and laboratory markers of stress, hyponatremia and severity of CSW using pre-defined criteria.
RESULTS
There were 24 patients with TBM (12 with CSW) and 12 controls. The median age of patients was 31 (18-75) years and 12 (50 %) were females. TBM patients with CSW had significantly higher levels of catecholamines compared to controls (p < 0.001). TBM patients with CSW had higher levels of norepinephrine than those without CSW (p = 0.034). Sequential studies revealed that dopamine and epinephrine increased at the time of hyponatremia and declined on its correction. Severity of TBM was related to dopamine (p = 0.04) and severity of CSW was related to epinephrine (p = 0.016).
CONCLUSION
CSW in TBM seems to be related to catecholamine dysregulation.
背景
脑性盐耗综合征（CSW）在结核性脑膜炎（TBM）中很常见，据推测是由于肾血液供应的交感神经失调所致，但尚未得到证实。
目的
评估 TBM 伴 CSW 患者的血浆儿茶酚胺水平，并与应激标志物相关联。
材料与方法
TBM 的诊断基于临床、CSF 和 MRI 标准。儿茶酚胺水平在入院时、低钠血症时和低钠血症纠正时通过 LC-MS 进行测量。儿茶酚胺水平与应激、低钠血症和 CSW 严重程度的临床和实验室标志物使用预定义标准进行相关性分析。
结果
共纳入 24 例 TBM 患者（12 例伴 CSW）和 12 例对照组。患者的中位年龄为 31 岁（18-75 岁），其中 12 例（50%）为女性。与对照组相比，TBM 伴 CSW 患者的儿茶酚胺水平显著升高（p<0.001）。TBM 伴 CSW 患者的去甲肾上腺素水平高于不伴 CSW 患者（p=0.034）。序贯研究显示，多巴胺和肾上腺素在低钠血症时升高，并在低钠血症纠正后下降。TBM 的严重程度与多巴胺相关（p=0.04），CSW 的严重程度与肾上腺素相关（p=0.016）。
结论
TBM 中的 CSW 似乎与儿茶酚胺失调有关。
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