Metabolic Diseases Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
Medical Microbiology Research Center, Qazvin University of Medical Sciences, Qazvin, Iran.
J Bone Miner Metab. 2022 Jul;40(4):663-669. doi: 10.1007/s00774-022-01330-w. Epub 2022 May 31.
Despite the high prevalence of hypocalcemia in patients with COVID-19, very limited studies have been designed to evaluate etiologies of this disorder. This study was designed to evaluate the status of serum parameters involved in calcium metabolism in patients with COVID-19 and hypocalcemia.
This cross-sectional study was conducted on 123 hospitalized patients with COVID-19. Serum concentrations of PTH, 25 (OH) D, magnesium, phosphate, and albumin were assessed and compared across three groups of moderate/severe hypocalcemia (serum total calcium < 8 mg/dl), mild hypocalcemia (8 mg/dl ≤ serum total calcium < 8.5 mg/dl) and normocalcemia (serum total calcium ≥ 8.5 mg/dl). Multivariate analyses were performed to evaluate the independent roles of serum parameters in hypocalcemia.
In total, 65.9% of the patients had hypocalcemia. Vitamin D deficiency was found in 44.4% and 37.7% of moderate/severe and mild hypocalcemia cases, respectively, compared to 7.1% in the normal serum total calcium group (P = 0.003). In multivariate analysis, vitamin D deficiency was independently associated with 6.2 times higher risk of hypocalcemia (P = 0.001). Only a minority of patients with hypocalcemia had appropriately high PTH (15.1% and 14.3% in mild and moderate/severe hypocalcemia, respectively). Serum PTH was low/low-normal in 40.0% of patients with moderate/severe low-corrected calcium group. Magnesium deficiency was not associated with hypocalcemia in univariate and multivariate analysis.
Vitamin D deficiency plays a major role in hypocalcemia among hospitalized patients with COVID-19. Inappropriately low/low-normal serum PTH may be a contributing factor in this disorder.
尽管 COVID-19 患者低钙血症的患病率很高，但针对这种疾病病因的研究非常有限。本研究旨在评估 COVID-19 合并低钙血症患者钙代谢相关血清参数的状态。
本横断面研究纳入了 123 例住院 COVID-19 患者。评估并比较了三组患者（中重度低钙血症组[血清总钙<8mg/dl]、轻度低钙血症组[8mg/dl≤血清总钙<8.5mg/dl]和正常钙血症组[血清总钙≥8.5mg/dl]）的血清甲状旁腺素（PTH）、25（OH）D、镁、磷和白蛋白浓度。采用多变量分析评估血清参数在低钙血症中的独立作用。
共有 65.9%的患者存在低钙血症。与正常血清总钙组（7.1%）相比，中重度和轻度低钙血症组分别有 44.4%和 37.7%的患者存在维生素 D 缺乏（P=0.003）。多变量分析显示，维生素 D 缺乏与低钙血症的风险增加 6.2 倍独立相关（P=0.001）。仅有少数低钙血症患者的 PTH 适当升高（轻度和中重度低钙血症组分别为 15.1%和 14.3%）。在中重度低校正钙血症组中，40.0%的患者血清 PTH 水平低/正常低值。在单变量和多变量分析中，镁缺乏与低钙血症无关。
维生素 D 缺乏在 COVID-19 住院患者低钙血症中起主要作用。血清 PTH 水平不适当降低/正常低值可能是导致该疾病的一个因素。
