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目的:研究甲状旁腺激素(PTH)及血清钙水平与ICU脓毒症患者疾病严重程度和预后的关系。方法:将ICU20例脓毒症患者分为生存组和死亡组进行回顾性研究。在SIRS发生48h内开始监测PTH及血钙水平。并在1周内每天检测两组PTH及血钙水平。病情严重程度用急性生理和慢性健康评分(APACHEⅡ)来评估。将两组PTH和血钙水平进行比较,并分析APACHEⅡ评分与PTH、血钙水平的相关性。结果:第1天PTH平均水平生存组患者66.7%高于正常,死亡组患者100%高于正常;血钙平均水平生存组患者77.8%低于正常,死亡组100%低于正常。死亡组PTH水平在第1～6天显著高于生存组(P<0.05),死亡组血钙水平在第1～5天显著低于生存组(P<0.05)。并且APACHEⅡ评分与PTH水平(r=0.969,P<0.05)呈正相关,与钙水平(r=-0.827,P<0.05)呈负相关。结论:低钙血症及高PTH水平在脓毒症患者中很常见,且与疾病严重程度相关,并可能提示预后较差。
Objective: To investigate the relationship between parathyroid hormone (PTH) and serum calcium levels and the severity and prognosis of ICU sepsis patients. Methods: 20 ICU patients with sepsis were divided into survival group and death group for retrospective study. PTH and serum calcium levels began to be monitored within 48 h of SIRS. And in one week, two groups of PTH and serum calcium levels were detected daily. The severity of illness was assessed using the acute physiology and chronic health score (APACHE II). The two groups of PTH and serum calcium levels were compared and analyzed APACHE Ⅱ score and PTH, serum calcium levels. Results: On day 1, 66.7% of patients in the PTH mean survival group were higher than normal, and 100% of patients in the death group were higher than normal. 77.8% of the patients in the mean serum calcium group were below normal, and 100% of the death patients were lower than normal. PTH levels in the death group were significantly higher than those in the survival group from the first day to the sixth day (P <0.05). The level of serum calcium in the death group was significantly lower than that in the survival group from the first day to the fifth day (P <0.05). APACHE II score was positively correlated with PTH level (r = 0.969, P <0.05), but negatively correlated with calcium level (r = -0.827, P <0.05). CONCLUSION: Hypocalcemia and high PTH levels are common in septic patients and are associated with the severity of the disease and may indicate poor prognosis.