老年低钠血症三种特殊类型的临床比较

Comparison of Clinical Features of Three Special Different Types of Hyponatremia in Elders

目的:探讨老年低钠血症中的三种特殊类型综合征的临床特点,即抗利尿激素分泌不当综合征(SIADH)、脑性耗盐综合征(CSWS)、慢性病态细胞综合征(CSCS)。方法:回顾性分析84例老年(>65岁)低钠血症的类型、基础病因及发病机制、临床表现特点、生化检查、治疗措施以及预后的差异。结果:根据临床表现及生化检查将所有病例分为SIADH组、CSWS组和CSCS组。基础病因有部分重叠,但在SIADH组以肿瘤多见(50%);CSWS组以外伤为主(50%);CSCS组以慢性消耗性疾病多见(54.5%)。各组(依次为SIADH,CSWS,CSCS)临床表现相似。血清钠水平在各组无明显差异[(126.5±4.6)mmol/L VS(125.4±7.8)mmol/L VS(126.3±6.0)mmol/L,P>0.05],尿钠水平在CSWS组最高[(45.5±2.4)mmol/L VS(65.3±7.3)mmol/L VS(35.6±4.9)mmol/L,P<0.05];血浆渗透压测定值在SIADH组最低[(266.5±17.7)mOsm/kg VS(281.1±21.4)mOsm/kg VS(285.4±18.2)mOsm/kg,P<0.05];血浆渗透压间隙CSCS组明显升高[(4.9±3.1)mOsm/kg VS(5.4±2.8)mOsm/kg VS(17.1±6.4)mOsm/kg,P<0.01],并且该值在CSCS组随着低钠血症的纠正而降低[(17.1±6.4)mOsm/kg VS(11.2±5.1)mOsm/kg,P<0.05]。治疗在SIADH组以限水为主,CSWS组以补充钠盐及水容量为主,而CSCS组以纠正原发病为主。三组低钠血症的低钠纠正率分别为84.1%、83.3%、54.5%(P<0.05);病死率分别为10.5%、16.7%、13.6%(P<0.05)。结论:三种类型的低钠血症基础病因分别以肿瘤、外伤及慢性消耗性疾病为主。各组血清钠水平相似,CSWS组尿钠水平最高,血浆渗透压测定值在SIADH组最低,血浆渗透压间隙以CSCS组最高。治疗方法三组分别以限水、补钠补水、原发基础病治疗为主。CSCS组血清钠纠正率最低,三组预后均差,CSWS组的病死率最高。

Objective：To compare the clinical features of three special different types of hyponatremia in elders including syndrome of inappropriate antidiuretic hormone secretion （SIADH）,cerebral salt wasting syndrome （CSWS） and chronic sick cell syndrome （CSCS）. Methods ：To study 84 cases of three different kinds of hyponatremia in elders （〉65 years） by analyzing their basic diseases, pathogeny, clinical features, biochemistry tests, treatments and prognosis Retrospectively. Results：According to the clinical features and the biochemistry tests, we divided the patients into three groups including SIADH, CSWS and CSCS. There were some overlaps of the basic diseases in the three groups. In group of SIADH,half of cases were tumors; nearly 50% cases were traumas in group of CSWS and in CSCS group,the most reasons were chronic exhaustive diseases. The clinical features were same in each groups. The levels of the blood plasma sodium were similar in each group [（126.5±4.6） mmol/L VS （125.4±7.8） mmol/L VS （126.3±6.0） mmol/ L, P〉0.05）. The level of the urea sodium in group CSWS was the highest [（45.5±2.4） mmol/L VS （65. 3±7.3） mmol/L VS （35.6±4.9） mmol/L,P〈0.05]. The tested plasma osmoalality （tPosm） in group SIADH was the lowest [（266. 5±17. 7） mOsm/kg VS （281.1±21.4） mOsm/kg VS （285.4 ±18.2） mOsm/kg,P〈0.05）. The osmolar gap （OG） in CSCS was the highest [（4. 9±3. 1） mOsm/kg VS （5.4±2.8） mOsm/kg VS （17. 1±6.4）mOsm/kg,P〈0.01], and in CSCS, the value of OG decreased while correcting the hyponatremia（17.1±6. 4） mOsm/kg VS （11.2± 5.1） mOsm/kg,P〈0.05]. The treatment of hyponatremia in the three groups was quite different. The main methords were restricting water in SIADH while in CSWS supplying sodium and water, and in CSCS curing the basic diseases. The correction rates of hyponatremia in three groups were 10.5%,16.7% ,and 13. 6% respectively （P〈0.05）. The death rate of each prognosis was 10.5 %, 16.7 %, 13.6 % （P%0.05）respectively. Conclusion ：The principal basic diseases in the three group are tumors, traumas and chronic exhaustive diseases respectively. The level of blood plasma sodium is the similar in the three groups. The highest level of urea sodium and OG are the groups of CSWS and CSCS respectively. The lowest level of tPosm is group of SIADH. The remedying rate of hyponatremia in CSCS is the lowest, and the prognosis in the three are all bad while the death rate in group of CSWS is the highest.