Department of Neurology, Incheon St. Mary's Hospital, The Catholic University of Korea, Seoul, 06591, Korea.
Department of Neurology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Sci Rep. 2021 May 25;11(1):10906. doi: 10.1038/s41598-021-90358-5.
We evaluated the association between hyponatremia and tuberculous meningitis (TBM) with the aim of providing additional information for differential diagnosis from other types of infectious meningitis, especially viral meningitis (VM). Cross-sectional and longitudinal data involving 5026 participants older than 18 years were analyzed in the total population and a propensity-matched population. The initial and lowest sodium levels and longitudinal changes in TBM, bacterial meningitis (BM), and VM patients were compared. Participants in the TBM group were enrolled when they were diagnosed as possible, probable, or definite TBM according to the Marais' criteria. The initial serum sodium level was significantly lower in TBM patients than in BM and VM patients (136.9 ± 5.9 vs. 138.3 ± 4.7 mmol/L, p < 0.001 for TBM vs. BM, and 139.0 ± 3.1, p < 0.001 for TBM vs. VM), and it decreased significantly more steeply to lower levels in both the TBM and BM patients compared with VM patients. The lowest serum sodium level was in the order of TBM < BM < VM patients, and the change was statistically significant in all subgroups (131.8 ± 6.4, 133.1 ± 5.1, 137.4 ± 3.7, respectively, p < 0.001). Participants with lower serum sodium level were more likely to have a diagnosis of TBM rather than VM, and this association was more pronounced for the lowest sodium level than the initial sodium level [OR 4.6 (95% CI 2.4-8.8, p < 0.001)]. These findings indicate that baseline and longitudinal evaluation of serum sodium level can provide information for differential diagnosis of TBM from BM or VM.
我们评估了低钠血症与结核性脑膜炎（TBM）之间的关联，旨在为鉴别诊断提供额外信息，以区别于其他类型的感染性脑膜炎，尤其是病毒性脑膜炎（VM）。在总人群和倾向评分匹配人群中分析了涉及 5026 名年龄大于 18 岁的参与者的横断面和纵向数据。比较了 TBM、细菌性脑膜炎（BM）和 VM 患者的初始和最低钠水平以及纵向变化。当参与者根据 Marais 标准被诊断为可能、可能或明确的 TBM 时，他们被纳入 TBM 组。TBM 患者的初始血清钠水平明显低于 BM 和 VM 患者（136.9±5.9 与 138.3±4.7mmol/L，TBM 与 BM 相比，p<0.001；139.0±3.1，TBM 与 VM 相比，p<0.001），并且与 VM 患者相比，TBM 和 BM 患者的血清钠水平下降得更陡峭，更低。最低血清钠水平的顺序为 TBM<BM<VM 患者，并且在所有亚组中均存在统计学差异（分别为 131.8±6.4、133.1±5.1、137.4±3.7，p<0.001）。血清钠水平较低的参与者更有可能被诊断为 TBM，而不是 VM，并且这种关联在最低钠水平比初始钠水平时更为明显[比值比 4.6（95%置信区间 2.4-8.8，p<0.001）]。这些发现表明，基线和纵向评估血清钠水平可以为 TBM 与 BM 或 VM 的鉴别诊断提供信息。
