Browner Warren, Haber Richard
California Pacific Medical Center, San Francisco, California, United States of America.
PLoS One. 2007 Dec 26;2(12):e1380. doi: 10.1371/journal.pone.0001380.
Hypophosphatemia occurs in 40 to 60% of patients with acute malaria, and in many other conditions associated with elevations of body temperature. To determine the prevalence and causes of hypophosphatemia in patients with malaria, we retrospectively studied all adults diagnosed with acute malaria during a 12-year period. To validate our findings, we analyzed a second sample of malaria patients during a subsequent 10-year period. Serum phosphorus correlated inversely with temperature (n = 59, r = -0.62; P<0.0001), such that each 1 degrees C increase in body temperature was associated with a reduction of 0.18 mmol/L (0.56 mg/dL) in the serum phosphorus level (95% confidence interval: -0.12 to -0.24 mmol/L [-0.37 to -0.74 mg/dL] per 1 degrees C). A similar effect was observed among 19 patients who had repeat measurements of serum phosphorus and temperature. In a multiple linear regression analysis, the relation between temperature and serum phosphorus level was independent of blood pH, PCO2, and serum levels of potassium, bicarbonate, calcium, albumin, and glucose. Our study demonstrates a strong inverse linear relation between body temperature and serum phosphorus level that was not explained by other factors known to cause hypophosphatemia. If causal, this association can account for the high prevalence of hypophosphatemia, observed in our patients and in previous studies of patients with malaria. Because hypophosphatemia has been observed in other clinical conditions characterized by fever or hyperthermia, this relation may not be unique to malaria. Elevation of body temperature should be added to the list of causes of hypophosphatemia.
40%至60%的急性疟疾患者会出现低磷血症，在许多其他与体温升高相关的病症中也会出现。为了确定疟疾患者低磷血症的患病率及病因，我们回顾性研究了在12年期间内所有被诊断为急性疟疾的成年患者。为验证我们的研究结果，我们在随后的10年期间分析了另一组疟疾患者样本。血清磷与体温呈负相关（n = 59，r = -0.62；P<0.0001），即体温每升高1摄氏度，血清磷水平降低0.18 mmol/L（0.56 mg/dL）（95%置信区间：每1摄氏度-0.12至-0.24 mmol/L [-0.37至-0.74 mg/dL]）。在19名重复测量血清磷和体温的患者中也观察到了类似的效应。在多元线性回归分析中，体温与血清磷水平之间的关系独立于血液pH值、PCO2以及钾、碳酸氢盐、钙、白蛋白和葡萄糖的血清水平。我们的研究表明，体温与血清磷水平之间存在强烈的负线性关系，且这种关系无法用其他已知导致低磷血症的因素来解释。如果存在因果关系，这种关联可以解释在我们的患者以及先前疟疾患者研究中观察到的低磷血症的高患病率。由于在其他以发热或体温过高为特征的临床病症中也观察到了低磷血症，这种关系可能并非疟疾所特有。体温升高应被列入低磷血症的病因清单中。
