Objective

Tuberculous meningitis (TBM) is a common infection of the central nervous system. TBM with hyponatremia is very common. If hyponatremia is not treated properly, it might affect the outcome of TBM patients.

Methods

We included 226 patients diagnosed with TBM who were admitted from August 2010 to August 2015 and retrospectively analyzed the clinical data of patients with and without hyponatremia.

Results

In total, 45.6% (103/226) patients had hyponatremia and 54.4% (123/226) patients did not have hyponatremia. Serum sodium and severity of TBM were independent prediction factors of poor outcomes in TBM. The prognosis of patients with hyponatremia was worse than that of patients without hyponatremia. The mortality was 3.9% (4/103) in the hyponatremia group, while 0% (0/123) in the non-hyponatremia group. The degree of hyponatremia was related to imaging, cerebrospinal fluid (CSF) cell count and protein, severity of TBM, time to correct hyponatremia, and prognosis. We analyzed the causes of hyponatremia and found syndrome of inappropriate secretion of antidiuretic hormone (SIADH) was the most common cause (77.7%, 80/103), followed by cerebral salt wasting (CSW) (17.5%, 18/103). Comparing SIADH and CSW, there was a significant difference in mean blood pressure, albumin, and hematocrit, and no significant difference in demographic characteristics, imaging, CSF cell count and protein, severity, occurrence and correction time of hyponatremia, or prognosis.

Conclusion

TBM with hyponatremia was dominated by moderate hyponatremia, which often manifested as SIADH. The more severe hyponatremia was, the longer the correction time of hyponatremia, which will affect the prognosis of TBM patients.

中文翻译：

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成人结核性脑膜炎合并低钠血症103例临床分析

客观的

结核性脑膜炎 (TBM) 是一种常见的中枢神经系统感染。伴有低钠血症的 TBM 很常见。如果低钠血症治疗不当，可能会影响 TBM 患者的预后。

方法

我们纳入 2010 年 8 月至 2015 年 8 月入院的 226 例 TBM 患者，回顾性分析有无低钠血症患者的临床资料。

结果

总共有 45.6% (103/226) 的患者出现低钠血症，54.4% (123/226) 的患者没有出现低钠血症。血清钠和TBM严重程度是TBM预后不良的独立预测因素。低钠血症患者的预后比无低钠血症的患者差。低钠血症组死亡率为3.9%（4/103），非低钠血症组死亡率为0%（0/123）。低钠血症的程度与影像学、脑脊液（CSF）细胞计数和蛋白、TBM的严重程度、纠正低钠血症的时间和预后有关。我们分析了低钠血症的原因，发现抗利尿激素分泌异常综合征（SIADH）是最常见的原因（77.7%，80/103），其次是脑性盐耗（CSW）（17.5%，18/103）。比较 SIADH 和 CSW，

结论

伴有低钠血症的TBM以中度低钠血症为主，常表现为SIADH。低钠血症越严重，低钠血症的纠正时间越长，影响TBM患者的预后。