低钠血症患者渗透性脱髓鞘综合征发病危险因素的回顾性研究

Risk factors for osmotic demyelination syndrome in patients with hyponatremia: a retrospective study

目的探讨低钠血症患者发生渗透性脱髓鞘综合征(ODS)的危险因素。方法回顾性分析我院2009年1月至2014年5月收治的血钠低于130 mmol/L低钠血症患者,收集其发生ODS的临床资料,比较发生ODS与未发生ODS两组患者相关临床指标的差异,通过多因素Logistic回归确定ODS发病的危险因素。结果共纳入240例低钠血症患者,其中12例(5.00%)发生ODS。ODS组患者血钠水平更低[114.6(108.0~117.5)mmol/L vs.122.3(118.2~124.3)mmol/L,P<0.001],且更多存在慢性低钠血症(100.00%vs.7.46%,P<0.001)、纠正低钠速度过快(83.33%vs.4.82%,P<0.001)、营养状态不良(58.33%vs.6.58%,P<0.001)、脏器功能衰竭(66.67%vs.18.86%,P=0.001)、严重感染(50.00%vs.3.95%,P<0.001)、长期使用利尿剂(75.00%vs.14.91%,P<0.001)、慢性酒精中毒等因素(16.67%vs.0%,P<0.001)。而在性别、年龄、血压、血钾浓度、空腹血糖浓度、总胆固醇浓度、甘油三酯浓度、纤维蛋白原浓度、颅脑病变史、长期吸烟史等方面,两组患者间差异不具有统计学意义(P>0.05)。结论严重低血钠、慢性低钠血症病史、纠正低钠速度过快、营养不良、脏器功能衰竭、严重感染、长期应用利尿剂、慢性酒精中毒等可能是ODS发病的危险因素。提示在临床上对存在上述高危因素的患者,更应控制补钠速度及进行综合治疗。

Objective To investigate the risk factors for the onset of osmotic demyelination syndrome(ODS) in patients with hyponatremia. Methods Consecutive patients admitted in our hospital during January 2009 to May 2014, with serum sodium level lower than 130 mmol/L, were included in this study. Data of occurrence of ODS and relevant clinical parameters were retrospectively collected. Risk factors for the onset of ODS were determined by comparing the differences between ODS and non-ODS patients. Binary Logistic regression was planned for multivariate analysis. Results 240 patients with hyponatremia were included, with 12 cases of ODS. Compared with non-ODS patients, serum sodium level was lower [114.6(108.0-117.5)mmol/L vs. 122.3(118.2-124.3)mmol/L, P<0.001], and presence of chronic hyponatremia(100.00% vs. 7.46%, P<0.001), rapid correction of hyponatremia(83.33% vs. 4.82%, P<0.001), malnutrition(58.33% vs. 6.58%, P<0.001), organ failure(66.67% vs. 18. 86%, P=0.001), severe infection(50.00% vs. 3.95%, P<0.001), long-term use of diuretics(75.00% vs. 14.91%, P<0.001) and chronic alcoholism(16.67% vs. 0%, P<0.001) were more common in ODS patients. There was no significant difference in gender, age, blood pressure, serum potassium, fasting blood glucose, cholesterol, triglyceride, fibrinogen, brain disease history and long-term smoking history between the two groups of patients(P>0.05). Conclusions Severe hyponatremia, chronic hyponatremia, rapid correction of hyponatremia, malnutrition, organ failure, severe infection, long-term use of diuretics and chronic alcoholism may be risk factors for the onset of ODS. It suggests that slow correction of hyponatremia and comprehensive therapy is especially important in patients with these risk factors in clinical practice.