脓毒症患者血钙的影响因素及对预后的影响

Influencing factors of serum calcium and the role of serum calcium on prognosis in sepsis patients

目的分析脓毒症患者血钙水平，了解患者钙代谢异常的影响因素，并分析血钙水平对预后的影响。方法收集2017年1月1日至2018年1月31日收治住院的脓毒症患者的临床资料，以入院24 h内测定的血钙水平，将患者分成两组：正常血钙组（血钙2.03～2.67 mmol/L）和低血钙组（血钙〈2.03 mmol/L），未发现高血钙患者。收集比较两组患者的相关实验室检测指标。结果共纳入脓毒症患者52例，其中血钙正常14例，低血钙38例，低钙血症发生率为73.1% （38/52），低血钙组血钙（1.78 ± 0.17）mmol/L，正常血钙组血钙（2.16 ± 0.14）mmol/L。脓毒症的感染部位主要为消化、呼吸、泌尿系统。与正常血钙组比较，低血钙组的营养不良人数较多，反映营养情况的总蛋白（TP）、白蛋白（ALB）、前白蛋白（PAB）、总胆固醇（TCH）均低，序贯器官衰竭（SOFA）评分高，凝血酶原活动度（PTA）低，凝血酶原时间（PT）延长，国际标准化比值（INR）升高，差异均有统计学意义（P〈0.05或〈0.01）。应用Pearson相关性检验，筛选与血钙相关的影响因素，血钙浓度与SOFA评分、降钙素原（PCT）、PTA、PT、活化部分凝血活酶时间（APTT）、INR水平呈中等程度负相关（r=- 0.431、- 0.361、- 0.441、- 0.431、- 0.427、- 0.420，P〈0.01或〈0.05）；血钙浓度与TCH、TP、ALB、PAB水平呈中等程度正相关（r=0.442、0.475、0.463、0.419，P〈0.01）。结论低钙血与机体的营养状况相关，与凝血功能、血清蛋白水平、PCT浓度、SOFA评分有相关性。血钙下降提示患者更易于出现多器官功能障碍综合征，须加以关注。

Objective To retrospectively analyze the serum calcium level in sepsis patients, understand the influencing factors of abnormality calcium metabolism, and analyze the effect of serum calcium level on sepsis prognosis.MethodsFrom January 1, 2017 to January 31, 2018, clinical data about sepsis patients admitted hospital were collected. The patients were divided into 2 groups according the levels of serum calcium measured in patients admitted in 24 h： normal serum calcium group （serum calcium 2.03-2.67 mmol/L）, and low serum calcium group （serum calcium〈2.03 mmol/L）. And this study did not find hypercalcemia patients. The data about laboratory test index were compared between two groups.ResultsFifty-two cases were included in this study, including 14 cases of normal serum calcium and 38 cases of hypocalcemia, and the incidence rate of hypocalcemia was 73.1%（38/52）. The level of serum calcium in hypocalcemia group was （1.78 ± 0.17） mmol/L, and was （2.16 ± 0.14） mmol/L in normal serum calcium group. The main position of infections in patients with sepsis were digestive system, respiratory system and urinary system. Compared with that in the normal serum calcium group, the number of malnutrition patients in the hypocalcemia group was more. The total protein （TP）, albumin （ALB）, prealbumin （PAB） and total cholesterol （TCH） in the nutritional status of the patients were lower, the sequential organ failure assessment （SOFA） scores was higher, the prothrombin activity （PTA） was lower, the prothrombin time （PT） was prolonged, and international normalized ratio （INR） was increased. The differences were statistically significant （P〈0.05 or 〈0.01）. Pearson correlation test was used to screen the tests and scores related to the concentration of serum calcium. The results showed that the serum calcium concentration was negatively correlated with the level of SOFA scores, procalcitonin （PCT）, PTA, thrombin time （PT）, activated partial thromboplastin time （APTT） and INR （r=- 0.431, - 0.361, - 0.441, - 0.431, - 0.427, - 0.420, P〈0.01 or〈0.05）, and the serum calcium concentration was positively correlated with TCH, TP, ALB and PAB （r=0.442, 0.475, 0.463, 0.419, P〈0.01）.ConclusionsHypocalcemia is related to the nutritional status of the body, and is related to coagulation function, serum protein level, PCT concentration and SOFA scores. The decrease of serum calcium indicates that multiple organ dysfunction syndrome may occur, and should be paid more attention to.