2011-2020年新疆某三甲医院低钾血症病因构成及血钾特点分析

Analysis of the etiology and clinical characteristics of hypokalemia in a three A hospital in Xinjiang from 2011 to 2020

目的回顾性分析和总结低钾血症的病因、临床特征和人群分布,重点分析低钾血症相关疾病的特点、诊断,探讨低钾血症诊断和治疗中的常见误区,提出临床防治低钾血症的建议。方法收集2011年12月-2020年10月间,以“低钾血症”为出院诊断的患者4494例,分析其病因构成及特点。结果低钾血症住院患者4494例,年龄0岁-99岁,平均63岁;包括17种民族,其中汉族最多2464例(54.83%)。取患者入院时血清钾离子值,血清钾离子整体分布在3.16(3.33,2.92)mmol/L。在整体人群中,男女性(P=0.009)、汉族与少数民族(P=0.0016)、不同年龄(P=0.049)患者分布均有差异。在不同年龄人群及不同程度的低钾血症人群分组中,男女性(P=0.040)及民族分布(P=0.000)有差异。男性及青年(≤44岁)人群是该院中重度低钾血症人群的的独立危险因素(P=0.002、P=0.000)。在病因分析中:呼吸系统疾病有837例,占18.62%;心血管系统疾病有747例,占16.62%等。结论低钾血症有多种病因,不难作出准确的诊断和治疗。对于非典型病例及罕见病因,例如巴特综合征、吉特曼综合征、自身免疫性低钾血症患者,应特别留意诊断及治疗。对低钾血症应针对病因进行个体化治疗,避免误诊误治。

Objective To analyze and summarize the etiology,clinical manifestations,and population distribution of hypokalemia retrospectively,focusing on the characteristics,diagnosis,and differential diagnosis of endocrine-related hypokalemia,exploring common misunderstandings in the diagnosis and treatment of hypokalemia and proposing clinical recommendations for preventions and treatments of hypokalemia.Methods From December 2011 to October 2020,4494 patients diagnosed with“hypokalemia”were collected,and their etiology and characteristics were analyzed.Results There were 4494 hospitalized patients with hypokalemia,aged from 0 to 99 years,with an average of 63 years.There were 17 ethnic groups,including 2464(54.83%)of the Han nationality.When the patients were admitted to the hospital,the value of serum potassiumion was 3.16(3.33-2.92)mmol/L.In the whole population,there were differences in the distribution of patients between males and females(P=0.009),Han nationality and minority nationality(P=0.0016),different ages(P=0.049).In different age groups and the groups with different degrees of hypokalemia,there were still differences in male and female(P=0.040)and ethnic distribution(P=0.000).Male and young people(≤44 years old)were independent risk factors for moderate and severe hypokalemia in our hospital(P=0.002,P=0.000).In the etiological analysis,there were 837 cases of respiratory diseases,accounting for 18.62%;747 cases of cardiovascular diseases,accounting for 16.62%.Conclusion There are many causes of hypokalemia.It is not difficult to make accurate diagnoses and treatments.We should especially attention to the diagnosis and treatment of atypical cases and rare causes,such as Bartter syndrome,Gitelman syndrome and autoimmune hypokalemia.Individual treatments should be carried out according to the cause of hypokalemia to avoid misdiagnosis and mistreatment.