Narotam P K, Kemp M, Buck R, Gouws E, van Dellen J R, Bhoola K D
Department of Neurosurgery, University of Natal Faculty of Medicine, Durban, South Africa.
Neurosurgery. 1994 Jun;34(6):982-8; discussion 988. doi: 10.1227/00006123-199406000-00005.
Hyponatremia has been reported in up to one third of patients with intracranial disease and has frequently been associated with tuberculous meningitis, often complicated by hydrocephalus. The lowered plasma sodium levels were previously attributed to the syndrome of inappropriate secretion of antidiuretic hormone. A controlled prospective study of 24 patients with tuberculous meningitis and hydrocephalus was carried out. Analyses of serum electrolytes and cerebrospinal fluid were performed. Plasma and cerebrospinal fluid levels of atrial natriuretic peptide (ANP) and antidiuretic hormone (ADH) were measured by radioimmunoassay. Fifteen patients were found to be hyponatremic (plasma sodium < 130 mmol/L) and ANP levels of 12 to 1,488 pg/ml were present (median, 26 pg/ml). The remaining 9 patients had normal plasma sodium values between 130 and 145 mmol/L, and in these, plasma ANP values varied between 12 and 21.7 pg/ml (median, 12 pg/ml). The difference between these two groups was not statistically significant. (Control values from patients undergoing myelography were established to range between 12 and 40 pg/ml; median, 14.4 pg/ml.) ANP levels were undetectable in the cerebrospinal fluid in all. Plasma ADH levels in the hyponatremic group were between 7 and 159 pg/ml (median, 40 pg/ml). In the normonatremic group, plasma ADH levels of 25 to 250 pg/ml (median, 29 pg/ml) were obtained. (The controls ranged between 3.6 and 35 pg/ml; median, 10.4 pg/ml). In the hyponatremic group, there was a moderate negative correlation (r = -0.683) between plasma ANP and plasma sodium (P = 0.02). No correlation between plasma ADH and plasma sodium was found (r = -0.168; P = 0.62).(ABSTRACT TRUNCATED AT 250 WORDS)
据报道，高达三分之一的颅内疾病患者会出现低钠血症，且常与结核性脑膜炎相关，常并发脑积水。血浆钠水平降低以前被归因于抗利尿激素分泌不当综合征。对24例结核性脑膜炎合并脑积水患者进行了一项对照前瞻性研究。进行了血清电解质和脑脊液分析。采用放射免疫分析法测定心房利钠肽（ANP）和抗利尿激素（ADH）的血浆和脑脊液水平。发现15例患者为低钠血症（血浆钠<130 mmol/L），ANP水平为12至1488 pg/ml（中位数为26 pg/ml）。其余9例患者血浆钠值正常，在130至145 mmol/L之间，这些患者的血浆ANP值在12至21.7 pg/ml之间（中位数为12 pg/ml）。这两组之间的差异无统计学意义。（脊髓造影患者的对照值确定在12至40 pg/ml之间；中位数为14.4 pg/ml。）所有患者的脑脊液中均未检测到ANP水平。低钠血症组的血浆ADH水平在7至159 pg/ml之间（中位数为40 pg/ml）。在正常钠血症组中，血浆ADH水平为25至250 pg/ml（中位数为29 pg/ml）。（对照组在3.6至35 pg/ml之间；中位数为10.4 pg/ml）。在低钠血症组中，血浆ANP与血浆钠之间存在中度负相关（r = -0.683）（P = 0.02）。未发现血浆ADH与血浆钠之间存在相关性（r = -0.168；P = 0.62）。（摘要截取自250字）
