慢性阻塞性肺病急性发作期磷代谢的研究

对46例慢性阻塞性肺部疾病（COPD）急性发作期患者作血清和尿磷以及其它电解质、动脉血气分析、肾功能等生化指标测定。其中26例还作血清2、3-磷酸甘油酸（2、3-DPG），心动图超声等检查。发现低磷血症者14例，占30．4％；24小时尿磷减少者40例，占87．0％。左心功能，肾功能，肾磷阈值和2、3－DPG等指标，低磷血症组明显低于血磷正常组（P＜0．05）。对6例明显低血磷症者给予补磷（KH2PO420mmol／d），补磷后用力肺活量（FVC）比补磷前有明显增加（P＜0．05）。探讨影响COPD急性发作期患者低磷血症或磷缺乏的因素，认为以药物、肾功能、心功能和酸碱平衡紊乱的影响最大。

Hypophosphatemia in patients with exacerbation of chronic obstructive pulmonary disaese

Objective: To quantify the prevalence and severity of hypophosphatemia in patients with degrees of chronic obstructive pulmonary disease (COPD) or respiratory failure , investigate the factors of influencing metabolise of phosphorus in COPD or respiratory and evaluate the clinical fact of phosphate supplement on the severe hypophosphatemia. Methods: Serum and urine phosphorus, sodium, potassiun,chloride, calcium and magnesium, arterial blood gases analysis, renal function and other biochemical indexes were investigated in forty-six patients with exacerbation of COPD. Among them, 26 cases measured 2, 3 - diphosphoglycerate (2, 3 DPG ), pulmonary function and echocardiography. Results: It was showed that fourteen patients (30. 4 % ) had hypophosphatemia, forty patients(87. 1% ) had low values of urine phosphorus(< 16mmol/24h). Left ventricle of heart function, renal function, 2, 3 DPG and renal phosphate threshold (TmPO4/GFR) in hypophosphatemic group were all much lower than those in normophosphatemic group (P < 0. 05 ) . 20mmol of phosphorus(as KH2PO4 ) per day was given intravenously in six patients with severe hupophosphatemia. After phosphate supplementalion, pulmonary function,the forced vital capacity(FVC)improved significantily. Conclusion: The pharmacologic therapy, left heart function, renal function, and acid-base disorder were the most common factors which caused hypophosphatemia or phosphate depletion in patients with exacerbation of COPD. Ventilatory function improved after phosphate supplementation in the patients with severe hypophosphatemia.