慢性重型乙型肝炎大量血浆置换时血钙、甲状旁腺素和骨钙素的变化

目的 观察人工肝大量血浆置换治疗慢性重型乙型肝炎时患者血中钙离子(Ca2+)、总钙(TCA)、甲状旁腺素(PTH)和骨钙素(BGP)的动态变化,探讨其发生机制。方法 采用日本产KM8800型人工肝血液净化装置为20例慢性重型乙型肝炎患者进行血浆置换共36治疗次,每次置换同型冰冻血浆3000ml,比较治疗前、治疗后即刻和治疗后1h血中Ca2+、TCA、PTH和BGP的变化。同时,随机抽取体检正常者与置换治疗用血浆标本各10份作相应检测。结果 与治疗前比较,患者治疗后即刻Ca2+和TCA浓度明显降低(P<0.01),PTH和BGP显著提高(P<0.01)。治疗后1 h血清中除BGP外,Ca2+、TCA、PTH已基本恢复,与治疗前无明显差异(P>0.05)。与体检正常者比较,患者治疗前上述指标均无明显差异(P>0.05),置换治疗用血浆中Ca2+和TCA浓度极其减少(P<0.01),PTH和BGP无差异(P>0.05)。结论 大量血浆置换可造成慢性重型乙型肝炎患者发生低钙血症,这可通过患者体内PTH和BGP的调节作用短期内自行纠正。治疗中和治疗后应注意监控,以提高疗法的安全性。

The levels of Ca2+ , TCA, PTH and BGP in the blood of patients with chronic severe hepatitis B changed followed the massive plasma exchange

Objective To observe the levels of the ionized calcium (Ca2 + ), total calcium(TCA) , parathyroid hormone(PTH)and bone glaprotein (Osteocalcin, BGP) in the blood of the patients with chronic severe hepatitis B treated by the massive plasma exchange, and to explore its mechanisms. Methods The KM8800 type liver support system was used in the treatment of 20 cases with chronic severe hepatitis B (total 36 times of treatment), 3000ml frozen plasma with same blood group being used each time. The concentrations of Ca2+ , TCA, PTH and BGP in the blood of the patients before the treatments as well as just after the treatments and an hour later of the treatments were examined and compared. The same tests were also randomly taken in 10 samples of the plasma used for the exchanging purpose and in 10 samples of the blood of healthy adults, respectively. Results The concentrations of the Ca2 + and TCA in the blood of the patients reduced obviously when the treatments just began compared with that before the treat-ments(P<0.01), with PTH and BGP raised distinctly( P < 0.01). About an hour after the treatments, the levels of all tested indexes except BGP in serum almost return to normal. There was no distinction in the test between the blood of the patients before treatments and that of the healthy adults( P > 0.05). Ca2 + and TCA in the plasma used for exchanging decreased remarkably compared with that in blood of healthy adults (P < 0.01). Conclusion The massive plasma exchange can bring about hypocalcemia in the patients with chronic severe hepatitis B. It can be corrected by regulation of PTH and BGP in the patients themselves in short time. Such phenomena should be under monitor during and after treatments in order for the security of the therapy.