肺结核患者低钠血症与内分泌激素的相关性及对预后的影响

The correlation between hyponatremia and endocrine hormone in pulmonary tuberculosis patients and its effect on prognosis

目的评价肺结核患者低钠血症与内分泌激素的相关性及对预后转归的影响。方法前瞻性研究,入组27例初治肺结核患者,分为低钠血症组(10例)和正常血钠组(17例),收集其入院3天内的血浆,同时收集27例健康志愿者的血浆作对照,采用ELISA方法检测血浆皮质醇、促肾上腺皮质激素、抗利尿激素、肾素、硫酸脱氢表雄酮、醛固酮、血清脑钠素等激素水平,并比较组间激素水平的差异;将患者自住院之日起6个月内的预后分为好转和恶化(包括死亡),评估低钠血症对预后的影响。结果低钠血症组患者促肾上腺皮质激素、肾素明显升高,而硫酸脱氢表雄酮降低,与正常血钠组相比差异有显著性(P<0.05);与低钠血症组相比,正常血钠组6个月内的好转率更高,差异有显著性(P<0.05)。与健康对照组相比,肺结核患者血浆皮质醇、抗利尿激素及醛固酮升高、促肾上腺皮质激素、肾素及硫酸脱氢表雄酮降低,差异有显著性(P<0.05)。结论肺结核患者低钠血症的发生与内分泌激素水平的变化有关,可见促肾上腺皮质激素、肾素升高,硫酸脱氢表雄酮水平降低,且与预后有关。

Objective To evaluate the correlation between hyponatremia and endocrine hormone and the influence of hyponatremia on prognosis in pulmonary tuberculosis patients. Method Prospective study are performed for twenty-seven hospitalized patients with pulmonary of initial treatment tuberculosis. Ten patients in hyponatremia group and seventeen patients in normal sodium group. Twenty seven healthy volunteer in healthy control group. Peripheral ve-nous blood was collected. The plasma cortisol（ ACH） and adrenocorticotropic hormone（ ACTH） ,antidiuretic hormone （AVP）,renin（REN）,dehydroepiandrosterone sulfate（DHEA-S）,aldosterone（ALD）,and brain natruretic peptide （BNP）hormone levels were detected using enzyme-linked immunosorbent assay（ELISA）method and compare the differences between groups. We took a follow-up for 6 month. Their prognosis are divided into recovery and deteriora-tion（ including death） . We also assessed the effect of hyponatremia on prognosis. Result We found higher levels of ACTH and renin and lower level of DHEA-S in hyponatremia group（P〈0. 05）. The recovery rate was higher in non-hyponatremia group compared with hyponatremia group（P〈0. 05）. Compared with pepole in healthy control group, higher levels of ACH,AVP,ALD and lower levels of ACTH,renin,DHEA-S were found in patients with pulmonary tuberculosis（P〈0. 05）. Conclusion Hyponatremia in patients with pulmonary tuberculosis correlated with elevated ACTH and renin,decreased DHEA-S,which predicted poor prognosis in 6 months.