低钾性周期性瘫痪生化指标变化分析及治疗对策

Analysis and Treatment Strategies for Patients with Hypokalemic Periodic Paralysis and Serum Biochemical Changes

目的探讨生化指标变化在低钾性周期性瘫痪(hypokalemic periodic paralysis,HOPP)中的发生机制、变化规律及治疗对策。方法病例组33例,病人来诊后,立即采静脉血检验血钾、血磷、血钠、血氯、血糖和血钙,选择同期其他内科病例33例作为对照组,两组结果进行统计学分析。结果在HOPP33例中,生化检测值的变化具有一定规律性,血钾、血磷以降低、严重降低为主,血钾降低占100%,其中严重降低占48.5%;血磷降低占78.8%,其中严重降低占15.2%。血糖、血钠、血氯以升高为主,血糖升高占66.7%,最高达24.77mmol/L;血钠升高占75.8%,最高达149mmol/L;血氯升高占39.4%,最高达117mmol/L。各组生化检测构成比与对照组相比差异有统计学意义(P<0.05)。血钙大部分在正常范围内约81.8%。与对照组比较差异无统计学意义(P>0.05)。各项生化指标检测值水平,血钾、血磷明显降低,与对照组相比差异有统计学意义(P<0.05)。血糖、血钠、血氯检测值与对照组比较差异有统计学意义(P<0.05)。血钙检测值与对照组比较P>0.05,两组患者血钙水平差异无显著性意义。结论剧烈运动或劳累、酗酒、上呼吸道感染、治疗中应用地塞米松、静滴葡萄糖是导致HOPP发生及生化指标变化的主要诱因,尤其是低磷血症,在临床上应注意监测,及时纠正。上呼吸道感染患者的治疗,应尽量避免使用地塞米松和葡萄糖。

Objective To explore serum biachemistry indexes changes in hypokalemic periodic paralysis, its mechanism, changing rules and strategic treatment of patients. Method There were 33 patients in the disease group, after they visited hospital, their venous blood samples were collected and the blood potassium, phosphorus, sodium, chlorine, glucose and calcium were detected immediately. The 33 patients visited other department at the same time were treated as the control group. The results from two groups were statistically analyzed. Result Among 33 cases in HOPP, the changes of their biochemistry tests were regular; the blood potassium, phosphorus decreased and mainly seriously decreased. The blood potassium decrease accounted for 100%, in which serious decrease accounted for 48.5%; the blood phosphorus decrease accounted for 78.8%, in which serious decrease accounted for 15.2%. The blood glucose, sodium, chlorine increased, in which the blood glucose increase accounted for 66.7%, the highest glucose level was 24.77 retool/L; the blood sodium increase accounted for 75.8%, the highest sodium level was 149 mmol/L; the blood chlorine increase accounted for 39.4%, the highest chlorine level was 117 retool/ L. Compared with the control group, the constituent ratio of biochemistry tests had significant difference （P〈0.05）. The most blood calcium was at normal range about 81.8%, which had no significant difference compared with control group（P〉0.05）. In biochemistry index levels, the blood glucose, sodium, chlorine were significantly different with those in the control group （P〈0.05）. Compared with control group, the blood calcium in the disease group had no significant difference （P〉0.05）. Conclusion Heavy exercise or exertion, alcohol abuse, upper respiratory tract infection, dexamethasone administration, intravenous drip of glucose are the major factors leading to HOPP and changes of biochemistry indexes, in which the hypophosphatemia is important and needs to be monitored and corrected in clinics. Dexamethasone and glucose should not be used in those patients who had upper respiratory tract infections.