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低钙血症的临床表现

Author
David Goltzman, MD
Section Editor
Clifford J Rosen, MD
Deputy Editor
Jean E Mulder, MD
Translators
付建芳, 副主任医师，副教授

引言

低钙血症可伴有一系列临床表现(表 1)，如果低钙血症为轻度，则即使有症状也极少，而如果低钙血症为重度，则可出现危及生命的癫痫发作、难治性心力衰竭或喉痉挛。除了严重程度，低钙血症的发生速度和病程也对临床表现具有决定作用。

在低钙血症的症状中，手足搐搦、视乳头水肿和癫痫发作可见于低钙血症急性起病患者。相比而言，外胚层和牙齿改变、白内障、基底节钙化和锥体外系障碍是慢性低钙血症的特征。这些慢性改变最常见于甲状旁腺功能减退的患者。

本专题将讨论低钙血症的临床表现。低钙血症的病因、诊断方法和治疗将单独讨论。 (参见“成人低钙血症的病因学”和“低钙血症的诊断方法”和“低钙血症的治疗”和“甲状旁腺功能减退症”)

急性临床表现

急性低钙血症的标志是手足搐搦，其特征是神经肌肉易激惹。手足搐搦的症状可能较轻(口周麻木、手足感觉异常、肌肉痛性痉挛)，也可能较重(手足痉挛、喉痉挛，以及局灶性或全面性癫痫发作，全面性癫痫发作必须与发生于重度手足搐搦时的全身强直性肌肉挛缩进行鉴别)。部分患者的症状特异性较低，如乏力、高度易激惹、焦虑和抑郁。而部分患者即使有严重低钙血症，也没有神经肌肉症状。

手足搐搦 — 急性低钙血症直接增加了外周神经肌肉的易激惹性[1]。通过肌电图测定，手足搐搦表现为一次刺激后出现反复的高频放电。外周神经元过度兴奋很可能是低钙血症最重要的病理生理效应，但这种过度兴奋发生于任何水平的神经系统，包括运动终板、脊髓反射和中枢神经系统。

             

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Literature review current through: 2017-06 . | This topic last updated: 2017-04-07.
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