住院患者高钙血症的回顾性分析

发布时间：2018-03-22 04:27

本文选题：高钙血症　切入点：临床表现　出处：《吉林大学》2015年硕士论文　论文类型：学位论文

【摘要】：高钙血症是临床较常见急症之一，通常是某些严重疾病和恶性肿瘤的一种表现。轻者无任何症状，仅在常规筛查中发现血钙升高，重者可发生高钙危象，危及患者生命。因此，系统分析不同病因引起的高钙血症的临床特点、治疗及转归情况，对于指导临床决策、提高高钙血症患者的治愈率和生存率具有重要意义。目的：分析不同病因引起的高钙血症的临床特点、治疗及转归情况，并探讨其发生机制，进而提高临床上对该疾病的诊疗水平。资料与方法：选取2011年1月至2014年11月于我院各科住院并确诊为高钙血症的成年患者67例。根据患者出现高钙血症的病因分为四组：1组（恶性肿瘤）、2组（原发性甲状旁腺功能亢进）、3组（肾衰竭）及4组（其他类型疾病）。收集记录每一例患者的自然情况（性别、年龄）、患病原因、临床表现、治疗方法及时间、相关生化指标（血清钙、血清磷、尿素氮、肌酐）、血清白蛋白、碱性磷酸酶、血尿酸、促甲状腺激素、游离T3、游离T4、甲状旁腺激素、心电图、泌尿系彩超以及骨密度、骨扫描、X线/CT/MRI等相关骨骼系统检查。分析住院患者中不同病因引起的高钙血症的临床特点、治疗及转归。应用SPSSv22统计软件进行统计分析。结果：（1）住院患者中高钙血症最常见病因是恶性肿瘤（62.7%），其次是原发性甲状旁腺功能亢进（14.9%），其中恶性肿瘤相关性高钙血症最常见于多发性骨髓瘤（57.1%）。（2）经校正公式校正后血钙水平较校正前升高，且差异有显著统计学意义（P＜0.01）。（3）各组血钙水平排序依次为：2组＞1组＞3组＞4组，但各组血钙水平差异无统计学意义（P＞0.05）；2组高钙危象发生率最高（40.0%）。（4）本研究中高钙血症患者80%以上伴有不同系统临床表现，伴肌肉神经系统症状者最常见（59.7%），，其余依次是消化系统症状（50.7%）、骨骼系统症状（49.3%），一半以上患者伴有多个（≥2个）系统症状。（5）本研究中近一半患者出现骨骼系统症状，行骨骼系统检查发现近1/3患者出现骨骼系统病变，其中骨折、骨质疏松为常见骨骼改变。（6）轻、中、重不同程度高钙血症患者均以肌肉神经系统症状最为常见，伴有多个系统临床表现者随血钙程度增加而增加。（7）除水化扩容、利尿等常规方法外，降钙素为高钙血症最常用治疗药物（56.7%），但3组以血液透析/滤过/灌注为最常用治疗方法（66.7%）。（8）近1/3高钙血症患者3天内血钙可降至正常，一半以上一周内血钙可降至正常；1组死亡率高（14.6%）；各组高钙血症的转归情况差异无统计学意义（P＞0.05）。结论：（1）住院患者中高钙血症最常见的病因是恶性肿瘤，恶性肿瘤相关性高钙血症最常见于多发性骨髓瘤。（2）经校正公式校正后血钙水平较校正前升高；但不同病因所致高钙血症血钙水平无明显差异。（3）高钙血症住院患者80%以上伴有不同系统临床表现，肌肉神经系统、消化系统、骨骼系统症状均较常见，且常同时伴有多个（≥2个）系统症状。（4）除水化扩容、利尿等常规方法外，降钙素为临床上高钙血症最常用治疗药物。（5）恶性肿瘤引起的高钙血症预后差，死亡率较高。（6）临床上应提高对高钙血症的重视，进一步完善相关的诊断性化验及检查。
[Abstract]:Hypercalcemia is one of the common clinical emergency, usually is a manifestation of some serious diseases and malignant tumors. The light without any symptoms, found only in the routine screening of serum calcium, or high calcium crisis, endangering the lives of patients. Therefore, the system analysis of the clinical characteristics of different causes lead to hypercalcemia, treatment and prognosis and to guide clinical decision making, improve the cure rate of patients with hypercalcemia and survival is of great significance.
Objective: to analyze the clinical features of different causes of hypercalcemia, treatment and prognosis, and to explore its mechanism, and improve the clinical level of diagnosis and treatment of disease.
Materials and methods: from January 2011 to November 2014 in our hospital were admitted and diagnosed 67 cases of adult patients with hypercalcemia. According to the etiology of patients with hypercalcaemia were divided into four groups: group 1 (malignant tumor), 2 groups (primary hyperparathyroidism group (3), renal failure group (4) and other types of collect and record each disease). Patients with natural conditions (gender, age), risk factors, clinical manifestations, treatment methods and time related biochemical indicators (serum calcium, serum phosphorus, urea nitrogen, creatinine), serum albumin, alkaline phosphatase, blood uric acid, thyroid stimulating hormone, free T3, free T4, parathyroid hormone, electrocardiogram, urinary tract ultrasonography and bone density, bone scan, X-ray /CT/MRI and other skeletal system examination. Analysis of clinical characteristics of hospitalized patients with hypercalcemia induced by different causes, treatment and prognosis. SPSSv22 statistical software was used for statistical analysis Analysis.
Results: (1) the most common cause of hospitalization in patients with hypercalcemia is malignant tumor (62.7%), followed by primary hyperparathyroidism (14.9%), one of the most common malignancy associated hypercalcemia in multiple myeloma (57.1%). (2) the blood calcium level is adjusted before the correction formula is increased. And the difference was significant (P < 0.01).
(3) the order of blood calcium in each group was 2 groups > 1 groups > 3 groups > 4 groups, but there was no significant difference in blood calcium level between each group (P > 0.05), and 2 group had the highest incidence of high calcium crisis (40%).
(4) in this study, more than 80% of patients with hypercalcemia associated with different clinical manifestations of the system, the most common symptoms associated with neuromuscular system (59.7%), followed by gastrointestinal symptoms (50.7%), the symptoms of the skeletal system (49.3%), more than half of patients with multiple (2 or more) symptoms.
(5) nearly half of the patients in this study had skeletal system symptoms. Bone system examination revealed bone lesions in nearly 1/3 patients. Fractures and osteoporosis were common bone changes.
(6) light, heavy, in patients with different degree of hypercalcemia in neuromuscular system. The most common clinical manifestations accompanied by multiple system increases with the increase of calcium level. (7) in addition to hydration expansion, diuretic and other conventional methods, calcitonin is the most commonly used drug treatment of hypercalcemia (56.7%). But the 3 groups with hemodialysis / filtration / perfusion is the most commonly used treatment method (66.7%). (8) in 1/3 patients with hypercalcemia within 3 days of calcium can be reduced to normal within a week, more than half of calcium can be reduced to normal; 1 groups of high mortality (14.6%); there was no significant difference of the prognosis of hypercalcemia (P > 0.05).
Conclusion: (1) the most common cause of hospitalization in patients with hypercalcemia is malignant tumor, malignancy associated hypercalcemia is most common in multiple myeloma. (2) the blood calcium level is corrected before correction formula increased; but there was no significant difference in serum calcium level. Hypercalcemia caused by different etiology (3) more than 80% hospitalized patients with hypercalcemia with different clinical manifestations, neuromuscular system, digestive system, skeletal system symptoms are more common, and often accompanied by multiple (2 or more) system symptoms. (4) in addition to hydration expansion, diuretic and other conventional methods, calcitonin for clinical treatment of hypercalcemia most commonly used drugs. (5) hypercalcemia due to the poor prognosis of malignant tumor, the mortality rate is higher. (6) clinical attention should be increased to improve the diagnosis of hypercalcemia, testing and inspection of the further.

【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R589.5

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