Shirai M, Sato A, Suda T, Shichi I, Yasuda K, Iwata M, Okano A, Genma H, Chida K
Department of Internal Medicine Hamamatsu University School of Medicine, Shizuoka, Japan.
Kekkaku. 1990 Jun;65(6):415-20.
To investigate the role of Ca metabolism in granulomatous lung diseases, 187 patients with pulmonary tuberculosis 42 patients with sarcoidosis, and 47 patients with pneumonia were examined. The mean value of serum Ca on admission in tuberculosis patients was significantly lower than in patients with sarcoidosis. Of 183 patients with tuberculosis, 69 patients (38%) showed Ca level lower than normal range. The longitudinal observation of serum Ca level in 33 drug-responsive patients with tuberculosis disclosed that mean Ca level rose significantly at the third month of treatment, and maintained the similar level up to the sixth month. These findings suggest that the dynamics of Ca metabolism seen in tuberculosis were similar to that in pneumonia and differed from that in sarcoidosis, although both tuberculosis and sarcoidosis are characterized histologically by granuloma formation induced by cell-mediated immunity. To explain changes in Ca level, the chronological analysis of serum Vitamin D level was done, and it showed no correlation with serum Ca level. The lower serum Ca level on admission and their normalization according to the improvement of clinical course in tuberculosis have not been reported yet. It seems that there are responsible factors other than Vit D for Ca level fluctuation, and further studies are needed.
为研究钙代谢在肉芽肿性肺病中的作用，对187例肺结核患者、42例结节病患者和47例肺炎患者进行了检查。肺结核患者入院时血清钙的平均值显著低于结节病患者。在183例肺结核患者中，69例（38%）的钙水平低于正常范围。对33例药物反应性肺结核患者血清钙水平的纵向观察显示，治疗第三个月时平均钙水平显著升高，并在第六个月时维持在相似水平。这些发现表明，尽管肺结核和结节病在组织学上均以细胞介导免疫诱导的肉芽肿形成为特征，但肺结核中所见的钙代谢动态与肺炎相似，与结节病不同。为解释钙水平的变化，对血清维生素D水平进行了时间分析，结果显示其与血清钙水平无相关性。肺结核患者入院时血清钙水平较低，且随着临床病程的改善而恢复正常，这一点尚未见报道。似乎除了维生素D之外，还有其他因素导致钙水平波动，需要进一步研究。
