554例内分泌科住院患者低钾血症的病因和临床特点的回顾性分析:来自单中心的研究

Retrospective analysis of causes and clinical characteristics of 554 cases with hypokalemia in endocrinology department:a single-center study

目的探讨低钾血症的病因、临床特点及中重度低钾相关的危险因素。方法回顾性分析2006年1月到2018年12月山东省立医院内分泌科住院低钾血症患者554例。根据血钾水平分为轻、中、重度低钾,分析不同低钾程度的临床资料,应用Logistic回归分析评估低钾程度相关的影响因素。结果常见的低钾血症的病因依次为糖尿病[109例(19.68%)]、甲状腺功能亢进症[95例(17.15%)]和原发性醛固酮增多症[64例(11.55%)]。随着低钾程度的增加,男性比例、游离三碘甲腺原氨酸(FT3)、二氧化碳结合力(CO_(2)CP)逐渐升高,年龄、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)逐渐降低。除外病因不明相关的低钾血症,二分类Logistic回归分析结果显示,男性(OR=2.071,P=0.001)是中重度低钾的影响因素,甲状腺功能亢进症(OR=2.953,P<0.001)、原发性醛固酮增多症(OR=2.660,P=0.004)、肾小管酸中毒(OR=4.967,P<0.001)和Gitelman综合征(OR=7.326,P=0.015)患者发生中重度低钾的风险高于糖代谢异常患者。结论糖尿病、甲状腺功能亢进症和原发性醛固酮增多症是内分泌科住院患者低钾血症的相关因素,性别、病因是影响低钾严重程度的主要因素。

Objective To explore the causes,clinical features and influencing factors of moderate to severe hypokalemia.Methods The clinical data of 554 hospitalized patients with hypokalemia treated in the Endocrinology Department of Shandong Provincial Hospital during Jan.2006 and Dec.2018 were retrospectively analyzed.The patients were divided into mild,moderate and severe groups according to the serum potassium levels.The influencing factors of hypokalemia were determined with Logistic regression analysis.Results The causes of hypokalemia were diabetes(n=109,19.68%),hyperthyroidism(n=95,17.15%)and primary aldosteronism(n=64,11.55%).With the severity of hypokalemia,the ratio of male,free triiodothyronine(FT3)and carbon dioxide combining power(CO_(2)CP)increased,while age,total cholesterol(TC)level and low density lipoprotein-cholesterol(LDL-C)decreased.In Logistic regression analysis,except for hypokalemia caused by unknown causes,male(OR=2.071,P=0.001)was an influencing factor for moderate to severe hypokalemia,and patients with hyperthyroidism(OR=2.953,P<0.001),primary aldosteronism(OR=2.660,P=0.004),renal tubular acidosis(OR=4.967,P<0.001)and Gitelman?s syndrome(OR=7.326,P=0.015)had a higher risk for the patients with moderate to severe hypokalemia than those with abnormal glucose metabolism.Conclusion Diabetes,hyperthyroidism and primary aldosteronism are influencing factors for hypokalemia.Gender and etiology are independent influencing factors for moderate to severe hypokalemia.