甲状旁腺功能减退与急性低血钙的临床研究

目的探讨甲状旁腺功能减退与急性低血钙的发生与防治。方法收集急性低血钙患者57人，分为特发性甲旁减组36人、继发性甲旁减组21人（甲旁亢术后组11人和甲状腺术后组10人），另设正常对照组60人，分析甲状旁腺功能减退发生急性低血钙的诱因、诊断和防治。结果特发性甲旁减组、甲旁亢术后组和甲状腺术后组血清钙明显低于正常对照组（P〈0．001）。特发性和继发性甲旁减组的血清总钙值明显低于正常对照组（P〈0．001）。特发性甲旁减组血磷高于正常对照组（P〈0．05）；继发性甲旁减组血磷与正常对照组无显著性差异（P〉0．05）。特发性和继发性甲旁减组的CO2-CP与正常对照组比较，亦无显著性差异（P〉0．05）。结论甲状旁腺功能减退症出现低血钙的症状更多地取决于离子钙浓度的水平，其严重程度主要取决于血钙浓度下降的速率。预防急性低血钙，须长期控制慢性低血钙，使用Vit D制剂和口服钙盐，元素钙需足量。

Clinical Study of Hypocalcemic Crisis in Hypoparathyroidism

Objective To investigate the occurrence and treatment of hypocalcemic emergency with hypoparathyroidism. Methods Fifty-seven acute hypocalcemic patients were divided into idiopathic hypoparathyroidism group(n=36),post parathyroidectomy group(n=11),and post thyroidectomy group(n=10).Another 60 subjects were healthy normals.Analysis was made respect to diagnosis of hypoparathyroidism treatment of acute hypocalcemia,and cause of acute hypocalcemia. Results The levels of serum calcium were significantly lower in patients with idiopathic hypoparathyroidism,after parathyroidectomy and after thyroid surgery than those in controls(P<0.001).The serum calcium of idiopathic and secondary hypoparathyroidism was lower than the controls(P<0.001).The serum phosphorus of idiopathic hypoparathyroidism group was higher than that of controls(P<0.05);The differences of serum phosphorus were not significant between secondary hypoparathyroidism group and controls(P>0.05).The differences of the CO_2-CP were not significant between the idiopathic and secondary hypoparathyroidism group and controls(P>0.05). Conclusion Clinical features of hypocalcemia are owe,more to the actual level of free calcium concentration than serum calcium.The degree of severity in the hypocalcemic symptoms with hypoparathyroidism depends mainly on the rate of decline calcemia.Prevention in acute hypocalcemia,must control chronic hypocalcemia,intake of vitamin D preparation and oral calcium salts,and element calcium supplement must be sufficient.