Kalan Gorazd, Derganc Metka, Primožič Janez
Division for Paediatric Surgery and Intensive Care, University Medical Centre, Zaloška 7,1525 Ljubljana, Slovenia, Slovenia.
Pflugers Arch. 2000 Jan;440(Suppl 1):R109-R111. doi: 10.1007/s004240000026.
Very few data exist on phosphate metabolism in critically ill neonates. Therefore we studied the incidence of hypophosphataemia, the intracellular metabolism of phosphate by measuring adenosine 5'-triphosphate (ATP) and 2,3-diphosphoglycerate (2,3-DPG) in red blood cells, and excretion of phosphate in urine. The aims of the study were early detection of changes in phosphate metabolism as possible diagnostic markers of sepsis and defining the cause of hypophosphataemia.Neonates, treated in multidisciplinary paediatric intensive care unit (PICU), included in the study, were less than three days of age. Eighteen of them had respiratory distress syndrome (RDS) and 16 had microbiologically confirmed or clinical sepsis. The overall incidence of hypophosphataemia in critically ill neonates was over 80%, and was more common (88%) and more profound in those with sepsis than in those with RDS (79%). Therefore the septic neonates needed significantly larger amounts of phosphate to maintain normophosphataemia. In septic neonates ATP concentration in red blood cells was significantly lower than in neonates with RDS and controls, while the 2,3-DPG concentration was increased as a result of compensation. In septic neonates urinary losses of inorganic phosphate (Pi) were significantly higher than in neonates with RDS. Hypophosphataemia in critically ill neonates is at least partly due to higher urinary losses of phosphate.
关于危重新生儿磷酸盐代谢的数据非常少。因此，我们研究了低磷血症的发生率、通过测量红细胞中的三磷酸腺苷（ATP）和2,3 - 二磷酸甘油酸（2,3 - DPG）来研究磷酸盐的细胞内代谢，以及尿中磷酸盐的排泄情况。本研究的目的是尽早发现磷酸盐代谢的变化，将其作为败血症可能的诊断标志物，并确定低磷血症的原因。纳入研究的在多学科儿科重症监护病房（PICU）接受治疗的新生儿年龄小于3天。其中18例患有呼吸窘迫综合征（RDS），16例有微生物学确诊或临床败血症。危重新生儿低磷血症的总体发生率超过80%，败血症患儿中更为常见（88%）且程度更严重，高于RDS患儿（79%）。因此，败血症新生儿需要显著更多的磷酸盐来维持正常血磷水平。败血症新生儿红细胞中的ATP浓度显著低于RDS新生儿和对照组，而2,3 - DPG浓度因代偿而升高。败血症新生儿无机磷酸盐（Pi）的尿排泄量显著高于RDS新生儿。危重新生儿的低磷血症至少部分是由于尿中磷酸盐排泄增加所致。
