加压素和心钠素在结核性、新型隐球菌性脑膜炎患者低钠血症形成中的作用

THE EFFECT OF VASOPRESSIN AND ATRIAL NATRIURETIC FACTOR ON THE PATHOGENESIS OF HYPONATREMIA IN PATIENTS WITH TUBERCULOUS MENINGITIS AND CRYPTOCOCCUS MENINGITIS

选择经临床和病原学证实的结核性脑膜炎（结脑）８例，新型隐球菌脑膜炎（隐脑）７例。观察入院时、住院第１０、２０、３０和４０ｄ时血钠、颅内压及血浆和脑脊液（ＣＳＦ）中精氨酸加压素（ＡＶＰ）、心钠素（ＡＮＦ）含量的变化。结果表明，结脑和隐脑患者血浆和ＣＳＦ中ＡＶＰ含量显著高于对照组，隐脑患者血浆ＡＮＦ含量却明显低于对照组。且血钠浓度的变化与自身颅内压的变化趋势相反。血浆ＡＶＰ含量与血钠浓度之间呈显著负相关；血浆ＡＮＦ含量与血钠亦有明显相关性。ＣＳＦＡＶＰ含量与颅内压之间呈明显正相关。提示结脑和隐脑患者低钠血症及低钢性脑水肿的形成可能与体内ＡＶＰ和ＡＮＦ分泌异常，特别是中枢ＡＶＰ含量的异常增高有关。

cases of tuberculous meningitis(TM ) and 7 cases of cryptococcus meningitis (CM ), confirmed by etiological and clinical observations, were selected. Plasma sodium, intracra- nial pressure (ICP ), arginine vasopressin(AVP ) and atrial natriuretic factor(ANF ) contents in plasma and CSF were observed on the 1 0th , 20th , 30th and 40th day of the disease course,The results showed that plasma and CSF AVP contents in the patients of TM and CM were significantly increased , and the plasma ANF contents in CM were renlarkably decreased as compared with that of control. The changes in plasma sodium were oppsite to that of ICP in TM and CM. There was a negative correlation between plasma AVP and plasma sodium, and a positive correlation between plasma ANF and plasma sodium, There was also a positive correlation between CSF AVP and ICP. The data suggested that the formation of hyponatremia and hyponatrial brain edema in TM and CM patients might be related to the parasecretion of AVP and ANF inside the body , especially the abno- mal increase in central AVP contents.