严重产后出血并发急性肾损伤患者的 甲状旁腺激素变化的临床意义

Clinical significance of parathyroid hormone changes in patients with severe postpartum hemorrhage complicated with acute kidney injury

摘要:

目的 初步探讨严重产后出血并发急性肾损伤患者的甲状旁腺激素变化的临床意义。方法 采用前 瞻性研究，选取2014 年6 月-2016 年6 月该院严重产后出血并发急性肾损伤患者相关资料[ 年龄、总出血量、 总去甲肾上腺素（NA）的用量、肌酐（Cr）、离子钙（iCa2+）、离子磷（P）、急性生理与慢性健康（APACHE Ⅱ） 评分及甲状旁腺激素（PTH）] 进行统计学分析。结果 共收集符合条件患者80 例，分为并发急性肾损伤 （AKI）Ⅰ级组患者23 例，AKI Ⅱ级组患者34 例，AKI Ⅲ级组患者23 例，3 组在入重症加强护理病房（ICU） 时各项指标比较，其中，NA 总用量、iCa2+ 和P 比较，差异无统计学意义（P >0.05），而年龄、Cr、出血量、 APACHE Ⅱ评分及PTH 比较，差异有统计学意义（P =0.00）。3 组治疗前后的Cr、APACHE Ⅱ评分、iCa2+、 P 和PTH 比较，差异有统计学意义（P =0.00）。3 组在好转后转出ICU 时比较，Cr、APACHE Ⅱ评分和PTH 比较差异有统计学意义（P <0.05），iCa2+ 和P 差异无统计学意义（P >0.05）。PTH 和Cr、APACHE Ⅱ评分呈 正相关，与iCa2+ 无相关。结论 甲状旁腺激素在严重产后出血的急性肾损伤患者中的变化与病情严重程度有关， 和iCa2+ 关系不大。

Abstract:

Objective To investigate clinical significance of parathyroid hormone changes in patients with severe postpartum hemorrhage complicated with acute kidney injury (AKI). Methods Aretrospective study was performed on patients with severe postpartum hemorrhage complicated with AKI admitted into the first affiliated hospital of Bengbu medical college from June 2014 to June 2016. Age, total blood loss, total norepinephrine (NA), creatinine (Cr), calcium ion (iCa2+), ionic phosphorus (P), score and parathyroid hormone (PTH) were recorded. Results Totally 80 cases were identified, among which 23 cases had grade Ⅰ AKI, 34 patients had grade Ⅱ AKI and 23 patients hadgrade Ⅲ AKI. No significant differences in total amount of NA, iCa2+ and P were founded among the 3 groups (P > 0.05). Age, Cr, total blood loss, APACHE Ⅱ score, and PTH were differentially distributed among the 3 groups (P = 0.00). Standard treatment ameliorated dramatically clinical index of Creatinine, APACHE Ⅱ score, iCa2+, P and PTH compared withthose prior to any treatments (P = 0.00). Statistically significant differences in creatinine, APACHE Ⅱ score and PTH (P > 0.05) but not with iCa2+ and P (P > 0.05) were identified. Correlation analysis indicated a linear positive correlation between PTH and creatinine or APACHE Ⅱ score but no obvious correlation was identified between PTH and iCa2+. Conclusions Parathyroid hormone is correlated to the severity of disease in patients with severe postpartum hemorrhage complicated with AKI.