血清总钙水平对新型冠状病毒肺炎重症患者预后的判断价值

doi:10.3969/j.issn.1673-8640.2020.10.010

摘要/Abstract

摘要：

目的探讨血钙对新型冠状病毒肺炎（COVID-19）重症患者预后的判断价值。方法收集69例COVID-19重症患者的一般资料（性别、年龄、既往病史、并发症以及转归等）、入住隔离重症监护病房（ICU）24 h内的C反应蛋白（CRP）、降钙素原（PCT）、血糖、血清总钙（简称血钙）和急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）评分及28 d病死率。根据血钙水平分为正常血钙（血钙为2.11~2.52 mmol/L）组和低钙血症（血钙<2.11 mmol/L）组;根据28 d生存情况分为存活组和死亡组。采用Spearman相关分析评估各项指标之间的相关性。采用受试者工作特征（ROC）曲线评估血钙判断COVID-19重症患者预后的价值。采用Kaplan-Meier生存分析进行累计生存率的比较。结果 COVID-19重症患者低钙血症发生率为57.97%。低钙血症组慢性肾病患病率、年龄、CRP、血糖、APACHEⅡ评分及合并急性呼吸窘迫综合征（ARDS）、休克和低蛋白血症的比例均高于正常血钙组（P<0.05）,性别、PCT等其他项目2个组之间差异均无统计学意义（P>0.05）。Spearman相关分析结果显示,COVID-19重症患者血钙与CRP、血糖、APACHEⅡ评分均呈负相关（r值分别为-0.48、-0.41、-0.65,P<0.05）,而与 PCT无相关性（r=-0.18,P>0.05）。ROC曲线分析结果显示,血钙水平判断COVID-19重症患者预后的曲线下面积（AUC）为0.777。Kaplan-Meier生存曲线分析结果显示,低钙血症组28 d累计生存率显著低于正常血钙组（P=0.019）。结论 COVID-19重症患者合并低钙血症时预后较差,血钙或可作为判断COVID-19重症患者预后的指标。

关键词: 血钙, 新型冠状病毒肺炎, 严重急性呼吸综合征冠状病毒2, 低钙血症

Abstract:

Objective To investigate the role of serum calcium level in the prognosis of severe corona virus disease 2019（COVID-19） patients. Methods The data（sex,age,past medical history,complications,outcomes and so on）,C-reactive protein（CRP）,procalcitonin（PCT）,serum glucose,serum calcium and acute physiology and chronic health evaluation scoring system Ⅱ（APACHE Ⅱ） within 24 h of intensive care unit（ICU） admission and 28 d mortality of 69 patients with severe COVID-19 were collected and analyzed retrospectively. According to serum calcium levels,the patients were classified into normal group（serum calcium 2.11-2.52 mmol/L） and hypocalcemia group（serum calcium < 2.11 mmol/L）. According to 28 d prognosis,the patients were classified into survival group and death group. Spearman correlation analysis was used for correlation analysis. Receiver operating characteristic（ROC） curve was used to evaluate the diagnostic value of serum calcium level for prognosis. Kaplan-Meier survival analysis was used to compare accumulative survival rate. Results The incidence of hypocalcemia in patients with severe COVID-19 was 57.97%. The prevalence of chronic kidney disease,age,CRP,serum glucose,APACHEⅡ and the proportions of the complications of acute respiratory distress syndrome（ARDS）,shock and hypoalbuminemia in hypocalcemia group were higher than those in normal group（P<0.05）. However,there was no statistical significance in sex and PCT between the 2 groups（P>0.05）. Spearman correlation analysis showed that there was a negative correlation between serum calcium level and CRP,serum glucose and APACHEⅡ（r values were -0.48,-0.41 and -0.65,respectively,P<0.05）,but there was no correlation with PCT（r=-0.18,P>0.05）. ROC curve analysis showed that the area under curve（AUC） of serum calcium for predicting the prognosis of severe COVID-19 was 0.777. The 28 d accumulative survival rate of hypocalcemia group was lower than that of normal group through Kaplan-Meier survival analysis（P=0.019）.Conclusions The prognosis of severe COVID-19 patients with hypocalcemia is poor. Serum calcium may be used as a predictor for prognosis in patients with severe COVID-19.

Key words: Serum calcium, Corona virus disease 2019, Severe acute respiratory syndrome coronavirus 2, Hypocalcemia

中图分类号:

R446.1

汪建茹, 白欢, 张驰. 血清总钙水平对新型冠状病毒肺炎重症患者预后的判断价值[J]. 检验医学, 2020, 35(10): 1008-1012.

WANG Jianru, BAI Huan, ZHANG Chi. Diagnostic value of serum total calcium level in the prognosis of severe COVID-19 patients[J]. Laboratory Medicine, 2020, 35(10): 1008-1012.

图/表 5

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组别	例数	ARDS	休克	急性心脏损伤	AKI	肝脏损伤	低蛋白血症	酸碱异常
正常血钙组	29	7	4	5	2	3	1	2
低钙血症组	40	29	15	12	9	11	10	5
χ²值		15.76	4.74	1.47	2.00	3.06	4.33	0.13
P值		<0.01	0.03	0.23	0.16	0.08	0.04	0.72

组别	例数	ARDS	休克	急性心脏损伤	AKI	肝脏损伤	低蛋白血症	酸碱异常
正常血钙组	29	7	4	5	2	3	1	2
低钙血症组	40	29	15	12	9	11	10	5
χ²值		15.76	4.74	1.47	2.00	3.06	4.33	0.13
P值		<0.01	0.03	0.23	0.16	0.08	0.04	0.72

组别	例数	血钙/（mmol/L）	APACHEⅡ评分/分
存活组	56	2.11 ±0.17	9.84 ±2.72
死亡组	13	1.94 ±0.16	21.46 ±5.21
t值		3.239	-7.49
P值		<0.01	<0.01

组别	例数	血钙/（mmol/L）	APACHEⅡ评分/分
存活组	56	2.11 ±0.17	9.84 ±2.72
死亡组	13	1.94 ±0.16	21.46 ±5.21
t值		3.239	-7.49
P值		<0.01	<0.01