Carlstedt F, Lind L, Rastad J, Stjernström H, Wide L, Ljunghall S
University Hospital of Uppsala, Sweden.
Eur J Clin Invest. 1998 Nov;28(11):898-903. doi: 10.1046/j.1365-2362.1998.00391.x.
The present study explores serum parathyroid hormone (PTH) and blood ionized calcium (Ca2+) levels in relation to the severity of disease and mortality in the intensive care unit (ICU).
In a pilot study, 37 consecutive critically ill patients admitted to the ICU were studied with determinations of serum PTH and total serum calcium within the first 24 h. In a following prospective study, patients suffering from sepsis (n = 13) or subjected to major surgery (n = 13) were investigated daily for 1 week with determinations of serum PTH and ionized calcium (Ca2+). Severity of disease was assessed by the APACHE II score and hospital mortality was recorded.
In the pilot study, serum PTH levels were elevated (> 55 ng L-1) in 38% of the patients and were not related to serum calcium but showed a significant relationship to the APACHE II score (r = 0.39, P < 0.05). In the prospective study, serum PTH was elevated in 69% of the patients in both groups at inclusion, and 6 days later 87% of the septic and 37% of the surgery patients still showed elevated levels. Hypocalcaemia was more commonly seen in the septic patients [mean Ca2+ 1.03 +/- 0.08 (SD) mmol L-1] than in the surgical patients (1.14 +/- 0.06 mmol L-1) at inclusion. Both PTH and Ca2+ levels were significantly related to the APACHE II score (r = 0.46, P < 0.03, and r = -0.54, P < 0.009, respectively). Furthermore, PTH levels were significantly increased in non-survivors (n = 5) compared with survivors (mean 161 +/- 51 vs. 79 +/- 51 ng L-1, P < 0.005).
Hypocalcaemia and increased levels of PTH were common findings in critically ill patients. These alterations in calcium homeostasis were related to the severity of disease and increased PTH levels were associated with a poor outcome.
本研究探讨了重症监护病房（ICU）中血清甲状旁腺激素（PTH）和血离子钙（Ca2+）水平与疾病严重程度及死亡率的关系。
在一项初步研究中，对37例连续入住ICU的危重症患者在入院后24小时内测定血清PTH和总血清钙。在随后的一项前瞻性研究中，对脓毒症患者（n = 13）或接受大手术的患者（n = 13）进行为期1周的每日监测，测定血清PTH和离子钙（Ca2+）。通过急性生理与慢性健康状况评分系统II（APACHE II）评估疾病严重程度，并记录医院死亡率。
在初步研究中，38%的患者血清PTH水平升高（> 55 ng/L），与血清钙无关，但与APACHE II评分呈显著相关（r = 0.39，P < 0.05）。在前瞻性研究中，两组患者入院时69%的血清PTH升高，6天后，87%的脓毒症患者和37%的手术患者血清PTH仍升高。入院时，脓毒症患者低钙血症更为常见[平均Ca2+ 1.03±0.08（标准差）mmol/L]，而手术患者为（1.14±0.06 mmol/L）。PTH和Ca2+水平均与APACHE II评分显著相关（分别为r = 0.46，P < 0.03；r = -0.54，P < 0.009）。此外，与幸存者相比，非幸存者（n = 5）的PTH水平显著升高（平均161±51 vs. 79±51 ng/L，P < 0.005）。
低钙血症和PTH水平升高在危重症患者中很常见。这些钙稳态的改变与疾病严重程度相关，PTH水平升高与不良预后相关。
