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新生儿低钙血症

Author
Steven A Abrams, MD
Section Editors
Joseph A Garcia-Prats, MD
Joseph I Wolfsdorf, MB, BCh
Deputy Editor
Melanie S Kim, MD
Translators
张兆华, 副主任医师

引言

低钙血症是新生儿常见的代谢异常。

本文将总结新生儿低钙血症的诊断、临床表现和治疗。钙(Ca)的需求及新生儿期之后低钙血症的病因将在别处讨论。 (参见“新生儿骨骼健康的管理”和“婴儿和儿童低钙血症的病因”)

围生期代谢

妊娠期间，母体循环中的钙经胎盘上的钙泵主动转运至胎儿体内，此钙泵受甲状旁腺激素相关肽(parathyroid hormone-related peptide, PTHrP)的调节[1]。胎儿的钙积累大部分发生在妊娠晚期。这一过程导致胎儿血浆钙浓度高于母体，造成胎儿高钙血症：足月时脐血中总钙浓度为10-11mg/dL(2.5-2.75mmol/L)，钙离子浓度为6mg/dL(1.5mmol/L)[2]。

由于经胎盘的钙转运在出生时突然中断，出生后24小时的血清总钙浓度降至8-9mg/dL(2-2.25mmol/L)，钙离子浓度降至4.4-5.4mg/dL(1.1-1.35mmol/L)[3,4]。随后血清钙浓度逐渐上升，到出生后2周时达到年长儿童和成人的水平[5]。

检测

钙在血浆中以不同的形式参与循环。约40%的钙与血清蛋白结合，主要是与白蛋白结合；10%与枸橼酸盐、碳酸氢盐、硫酸盐或磷酸盐形成复合物；50%以具有重要生理意义的钙离子(游离钙)的形式存在[6]。钙离子的浓度受甲状旁腺激素和维生素D的严格调节。

                         

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Literature review current through: 2017-06 . | This topic last updated: 2016-11-29.
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