脓毒症患者血清甲状旁腺激素及钙水平与疾病严重程度及预后的关系

目的：研究甲状旁腺激素（PTH）及血清钙水平与ICU脓毒症患者疾病严重程度和预后的关系。方法：将ICU20例脓毒症患者分为生存组和死亡组进行回顾性研究。在SIRS发生48h内开始监测PTH及血钙水平。并在1周内每天检测两组PTH及血钙水平。病情严重程度用急性生理和慢性健康评分（APACHEⅡ）来评估。将两组PTH和血钙水平进行比较,并分析APACHEⅡ评分与PTH、血钙水平的相关性。结果：第1天PTH平均水平生存组患者66.7%高于正常,死亡组患者100%高于正常;血钙平均水平生存组患者77.8%低于正常,死亡组100%低于正常。死亡组PTH水平在第1～6天显著高于生存组（P〈0.05）,死亡组血钙水平在第1～5天显著低于生存组（P〈0.05）。并且APACHEⅡ评分与PTH水平（r=0.969,P〈0.05）呈正相关,与钙水平（r=-0.827,P〈0.05）呈负相关。结论：低钙血症及高PTH水平在脓毒症患者中很常见,且与疾病严重程度相关,并可能提示预后较差。

The relationship of parathyroid hormone and calcium levels with the severity of illness and prognosis in sepsis patients

Objective： To observe the correlation of Parathyroid hormone （PTH） and ionized calcium levels with the severity of illness and prognosis in sepsis patients. Method： In our retrospective study, 20 sepsis patients were selected and divided into two groups： survival patients （Group A） and the death （Group 13）. When SIRS occurred, levels of serum PTH and serum calcium in all patients were tested within the first 48 h. And they were investigated daily for 1 week. Severity of disease was assessed by the APACHE Ⅱ score. The PTH level and the calcium level between two groups were compared. The correlations between APACHE Ⅱ score and PTH and calcium were analyzed. Result：On the first day, the serum PTH levels were elevated in 66.7 % of the patients in group A, and 100% in group B. The incidence of hypocalcemia in group A was 77.8%, and 100% in group B. The serum PTH levels were significantly increased in group B compared with group A （P〈0.05） on the first six days. The serum calcium levels were significantly reduced in group B compared with group A （P〈0.05） on the first five days. Both PTH and Calcium levels were significantly related to the APACHE % score （r= 0. 969, P〈0.05, and r=-0. 827, P〈0.05, respectively）. Conclusion： Hypocaleaemia and increased levels of PTH were common findings in sepsis patients. These changes were related to the severity of disease and were associated with a poor outcome.