| Objective: To investigate the characteristics of clinical manifestations and laboratory examination of tuberculous meningitis(TBM)complicated with hyponatremia,and to study the impact of hyponatremia on the prognosis of TBM,so as to provide the basis for the clinical diagnosis and treatment of TBM complicated with hyponatremia.Methods: The clinical data of 142 patients with TBM in our hospital from February 2001 to January 2015 were retrospectively analyzed.The clinical manifestations and laboratory findings of patients with hyponatremia among them were analyzed according to different etiology and severity.Different treatment methods were used to correct the blood sodium level.The therapeutic effect after symptomatic treatment and the influence of hyponatremia on the prognosis of TBM were observed and analyzed.Results: 1 There were 55 cases complicated with hyponatremia among 142 patients with TBM ith a prevalence of 38.7%.The severities of hyponatremia were mainly mild to moderate(85.4%),and a small number of severe(14.5%).2 The clinical manifestations of hyponatremia of different severity had the obvious differences.Mild to moderate hyponatremia patients all have poor response,lethargy,fatigue,expression and clinical manifestations indifferent,and the majority of patients have symptoms of nausea and vomiting,loss of appetite,and some patients also have symptoms of cyanosis.Severe hyponatremia all complicated with headache,vomiting and strongly decreased blood pressure,and most patients have drowsiness,coma,irritability,clinical manifestations of cold limbs,and some part of patients also had convulsions and shortness of breath.3 Among 55 cases of TBM patients with hyponatremia syndrome,29 cases were caused by syndrome of inappropriate antidiuretic hormone(SIADH)(52.7%),and 26 cases were caused by cerebral salt wasting syndrome(CSWS)(47.3%).Among the 47 patients with mild to moderate hyponatremia,29 cases were caused by SIADH and 18 cases were caused by CSWS,while the 8 cases of severe hyponatremia were all caused by CSWS.4 Serum creatinine(SCr)levels were normal in patients with TBM combined with hyponatremia(P> 0.05).The plasma osmolality(POP)of patients with mild to moderate CSWS and SIADH were lower,and the urinary sodium concentration were increased,but the difference was not statistically significant(P> 0.05).The central venous pressure(CVP)in CSWS patients than that in SIADH patients(P< 0.05),and the blood usea nitrogen(BUN)levels in patients with SIADH were significantly lower than that in CSWS patients(P< 0.05).Urinary sodium concentrations of CSWS patients with severe hyponatremia were significantly higher,and the levels of POP and CVP were significantly lower than those of CSWS patients with mild to moderate hyponatremia(P< 0.05),while the BUN levels were both lower than normal without any significant difference(P> 0.05).5 After treatment,the blood sodium levels of 55 patients with TBM and hyponatremia were corrected.The time were 3.9± 1.6 days and 5.5± 2.9 days(P< 0.05)in patients with mild to moderate and severe hyponatremia,respectively.6 The total effective rate was 100% in patients with TBM.In patients with TBM complicated with mild to moderate hyponatremia,the cure rate was 85.1%,the total efficiency was 100%.While in patients with severe hyponatremia,the cure rate was only 25%,37.5% of the cases were invalid,the total efficiency wsa only 62.5%,significantly lower than those of mild to moderate hyponatremia(P< 0.05).But the treatment effects were quite in patients of TBM with mild to moderate hyponatremia and patients of TBM without hyponatremia(P> 0.05).The hospitalization time was 5~ 47 d.The average hospitalization time of patients with TBM,TBM complicated with mild and moderate hyponatremia,TBM complicated with severe hyponatremia were 14.5± 3.5 days,15.3± 5.6 days and 22.5± 11.1 days,respectively.The average hospitalization time of patients with severe hyponatremia was significantly longer than that of patients with mild to moderate hyponatremia(P< 0.05),while those of patients with mild to moderate hyponatremia and patients without hyponatremia had no significant difference(P> 0.05).Conclusion: 1 Hyponatremia is one of the common complications of TBM,mainly in mild to moderate,and a few are severe.2 The clinical manifestations of hyponatremia in patients with different severity have obvious differences.Along with the decrease of serum sodium levels,brain edema and nervous system damage aggravated,more and more serious symptoms of nervous system,motor system and digestive system are showed in clinical.3 The main causes of hyponatremia in TBM patients are SIADH and CSWS.Hyponatremia caused by SIADH is mostly mild and moderate,while that caused by CSWS is mostly severe.4 The laboratory examination results of hyponatremia patients with different severity and different etiology are obviously different,which has a guiding significance for the diagnosis and treatment of hyponatremia.5 We should pay attention to TBM patients with hyponatremia.Different normative treatment should be used to correct serum sodium levels as soon as possible according to the comprehensive consideration of the etiology and severity,and adjust the treatment plan according to the dynamic changes of serum sodium levels.But the correction of hyponatremia speed should not be too fast.6 Severe hyponatremia affects the treatment effect of TBM seriously,prolongs hospitalization time.The treatment of TBM and effective correction of hyponatremia is beneficial to improve the treatment effect of TBM... |
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