骨化三醇冲击治疗慢性肾衰竭继发性甲状旁腺功能亢进的临床疗效观察

目的 骨化三醇(罗盖全)冲击治疗慢性肾衰竭(CRF)患者继发性甲状旁腺功能亢进(SHPT)的临床疗效观察,方法选择24例慢性肾衰竭患者出现继发性甲状旁腺功能亢进,骨化三醇的治疗剂量是根据PTH的水平确定,观察骨痛及皮肤瘙痒情况,定期监测钙磷及PTH情况.结果 治疗3至6个月后PTH显著下降,骨痛及皮肤瘙痒明显改善.结论...     

饮食干预在维持性血液透析继发性甲状旁腺功能亢进症中的应用

目的探讨饮食干预在维持性血液透析继发性甲状旁腺功能亢进症患者中的应用价值。方法选取我院2018年1月至2019年3月期间收治的维持性血液透析继发甲状旁腺功能亢进症患者,随机分为常规组(常规护理)和实验组(常规护理+饮食干预),各46例。比较两组患者干预前、干预3个月的血磷、血钙、钙磷乘积、白蛋白、甲状旁腺激素水平以及护理满意度。结果干预前,两组的血磷、血钙、钙磷乘积、白蛋白、甲状旁腺激素水平比较无统计学差异(P>0.05);干预3个月后,实验组的血磷、钙磷乘积、甲状旁腺激素水平低于常规组,白蛋白水平高于常规组(P均<0.05)。实验组的护理满意度为97.83%,显著高于常规组的84.78%(P<0.05)。结论饮食干预应用于维持性血液透析继发甲状旁腺功能亢进症患者中,能有效调节患者的钙磷代谢,降低甲状旁腺激素水平,并提高患者的护理满意度。     

甲状旁腺全切加前臂自体移植术治疗慢性肾衰继发甲状旁腺功能亢进的疗效分析

目的 研究甲状旁腺全切加前臂自体移植术对慢性肾衰继发性甲状旁腺功能亢进的临床疗效.方法 对2005年1月～2010年12月期问在我院接受甲状旁腺全切除术加前臂自体移植术的维持性血液透析患者11例进行回顾性分析,随访观察临床症状的改善,并检测手术前后的全段甲状旁腺激素、血钙、血磷及钙磷乘积的变化.结果 患者术后症状明显缓解,无一例出现手术并发症.患者术后全段甲状旁腺激素、血钙、血磷及钙磷乘积较术前明显下降,有统计学意义.结论 甲状旁腺全切加前臂自体移植术治疗慢性肾衰继发性甲状旁腺功能亢进,是一种安全、有效的方法.     

成纤维细胞生长因子-23与慢性肾脏病

肾脏是维持人体磷酸盐内环境稳定的重要器官，它通过调节近端肾小管对磷酸盐的重吸收来维持血磷的平衡。慢性肾脏病（CKD）患者随着肾功能的减退对磷的调节能力下降，血磷的升高可以导致继发性甲状旁腺功能亢进和软组织钙化的发生，从而增加患者的病死率。以往认为，磷酸盐内环境的稳定是由涉及钙内环境稳定的因子调节的，如维生素D和甲状旁腺素（PTH），但后来研究表明限制饮食中磷酸盐的摄入可降低血PTH的浓度，延迟或改善继发性甲状旁腺功能亢进的发生，这一作用不依赖于血中的钙或钙化醇水平；     

口服醋酸钙对慢性肾功能衰竭高磷血症的作用

口服醋酸钙对慢性肾功能衰竭高磷血症的作用中国医科大学第一临床学院肾内科（１１０００１）栗霄立王力宁周希静慢性肾功能衰竭时尿磷排出减少，可导致高磷血症，相继引起继发性甲状旁腺功能亢进、肾性骨病及软组织钙化。故降低血磷在慢性肾衰治疗中具有重要意义。目前除...     

低钙透析联合碳酸钙及活性维生素D治疗继发性甲状旁腺功能亢进的疗效观察

目的研究低钙透析联合1、25(OH)2D3及碳酸钙治疗维持性血液透析患者继发性甲状旁腺功能亢进的有效性和安全性。方法选择维持性血透患者共30例,合并继发性甲状旁腺功能亢进。透析采用浓度为1.25 mmol/L的碳酸低钙透析液,口服碳酸钙每次1 500 mg,1次/d,口服活性维生素D每次0.75～1.0μg,每周2～3次,观察透析前后血钙、血磷、钙磷乘积和PTH。结果3个月后血钙维持正常水平,无显著性差异,血磷明显下降,有显著性差异(P<0.01),钙磷乘积明显下降,有显著性差异(P<0.01),IPTH明显下降,有显著性差异(P<0.01)。结论维持性血透合并继发性甲状旁腺功能亢进的患者,在口服碳酸钙骨化三醇(罗盖全)治疗过程中,应用低钙透析液进行透析,可以有效避免高钙血症及转移性钙化的出现,同时有效降低血磷、钙磷乘积,血清甲状旁腺激素水平。     

成纤维细胞生长因子-23与慢性肾脏病

肾脏是维持人体磷酸盐内环境稳定的重要器官,它通过调节近端肾小管对磷酸盐的重吸收来维持血磷的平衡。慢性肾脏病(CKD)患者随着肾功能的减退对磷的调节能力下降,血磷的升高可以导致继发性甲状旁腺功能亢进和软组织钙化的发生,从而增加患者的病死率。     

甲状旁腺全切加前臂移植术治疗尿毒症继发性甲状旁腺功能亢进的临床研究

目的研究甲状旁腺全切加前臂种植术治疗继发性甲状旁腺功能亢进症的临床疗效。方法回顾性分析韶关市第一人民医院于2014年6月-2015年6月期间收治的28例行甲状旁腺全切加前臂种植术治疗继发性甲状旁腺功能亢进的病例,对术前及术后3天、1周、1个月、3个月、6个月、1年的全段甲状旁腺激素(i PTH)、血钙、血磷、钙磷乘积、症状缓解情况、并发症等进行统计学分析。结果所有病例均顺利完成手术,术后骨骼关节疼痛均明显缓解,平均缓解时间1.5天,术后均未出现并发症;除2例复发外,术后3天、1周、1个月、3个月、6个月、1年的i PTH、血钙、血磷、钙磷乘积均较术前明显下降,有统计学意义;术后1年复发2例。结论甲状旁腺全切加前臂移植术能有效治疗继发性甲状旁腺功能亢进,手术安全,短期复发率低。     

血液透析滤过串联血液灌流联合骨化三醇冲击治疗对血透患者继发性甲状旁腺功能亢进的临床疗效

目的探讨血液透析滤过串联血液灌流联合骨化三醇冲击治疗对维持性血液透析患者并发继发性甲状旁腺功能亢进的临床疗效。 方法选取2019年01月至2019年06月60例维持性血液透析并发继发性甲状旁腺功能亢进的患者作为研究对象，其中男性42例，女性18例；年龄20～68岁，平均(52±17.2)岁。对照组30例，每周常规血液透析3次，联合骨化三醇冲击治疗；研究组30例，每周常规血液透析1次，血液透析滤过1次，血液透析滤过＋血液灌流1次，联合骨化三醇冲击治疗。观察两组患者血钙、血磷、血甲状旁腺素、碱性磷酸酶(ALP)等各项指标变化，并对两组患者的临床症状进行比较分析。 结果两组患者血甲状旁腺素均降低(P<0.05)；研究组患者的血甲状旁腺素、血磷、碱性磷酸酶明显低于对照组(P<0.05)；对照组治疗后血钙水平上升，较治疗前差异有统计学意义(P<0.05)；研究组治疗前后血钙水平差异无统计学意义(P>0.05)。 结论对维持性血液透析继发甲状旁腺功能亢进患者应用血液透析滤过串联血液灌流联合骨化三醇冲击治疗不仅能有效降低血甲状旁腺素、血磷、碱性磷酸酶水平，不影响血钙水平，且更能改善患者临床症状，提高生活质量。     

西那卡塞联合活性维生素D治疗终末期肾脏病继发性甲状旁腺功能亢进疗效及安全性的Meta分析

<正>慢性肾脏病(chronic kidney disease,CKD)因其高发病率、高住院率、高死亡率以及高治疗费用成为了威胁人类健康的重大疾病之一。而钙磷代谢紊乱所导致的继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)也是ESRD患者发生心脑血管事件的独立危险因素之一。西那卡塞及活性维生素D治疗终末期肾脏病继发性甲状旁腺功能亢进的作用机制各不相同,而两者联用是否取得更大疗效还尚未明确,本研究使用Meta分析及系统评价综合分析两者联用治疗的安全性及有效性。     

The diagnostic accuracy of high resolution ultrasound imaging for detection of secondary hyperparathyroidism in patients with chronic renal failure

Ultrasound is one of the preferred modalities for evaluation of the parathyroid glands. This study was undertaken to determine the accuracy of high resolution ultrasound for secondary hyperparathyroidism in patients with chronic renal failure. From March 2008 to March 2009, ninety-one hemodialysis patients were examined by high resolution ultrasound (14 MHz) of the parathyroid glands in comparison to parathyroid hormone level. 43.9% of patients showed enlarged parathyroid glands with an average of 8.7 mm. The mean parathyroid hormone level of patients with enlarged parathyroid glands on sonography was 503 ± 450 pg/ml. We observed a significant correlation between parathyroid hormone level and enlarged parathyroid glands (P<0.0001). Sensitivity and specificity of sonography for detection of secondary hyperparathyroidism were 62.5% and 85.7% respectively. In conclusion, our study showed that high resolution sonography is a useful noninvasive method for the evaluation of secondary hyperparathyroidism in patients on hemodialysis and that sonographically enlarged glands may be a measure of severity of secondary hyperparathyroidism.     

西那卡塞联合骨化三醇治疗慢性肾衰竭透析患者继发甲状旁腺功能亢进的效果观察

目的观察西那卡塞联合骨化三醇治疗慢性肾衰竭(chronic renal failure,CRF)透析继发甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)患者的效果。方法选取东莞市第八人民医院血液净化中心收治的28例CRF继发SHPT的患者作为研究对象,依据随机数字表法分为观察组(n=14)及对照组(n=14),两组均给予透析治疗,对照组采用骨化三醇大剂量间歇疗法(也称冲击治疗),观察组在对照组的基础上联合西那卡塞治疗,治疗3个月后,比较两组血钙、血磷及全段甲状旁腺激素(intact parathyroid hormone,iPTH)水平及不良反应发生情况。结果治疗后,观察组血钙、血磷、iPTH及钙磷乘积均明显优于对照组,差异有统计学意义(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论西那卡塞联合骨化三醇治疗CRF透析SHPT患者,可有效改善其血钙、血磷及iPTH水平,且不会增加不良反应。     

Sevelamer with and without calcium and vitamin D: observations from a long-term open-label clinical trial.

OBJECTIVE: To determine the effects of sevelamer hydrochloride on serum phosphorus, calcium, calcium x phosphate product, and parathyroid hormone (PTH) in patients treated with and without vitamin D metabolites and calcium supplementation. DESIGN: Long-term, open-label clinical trial. SETTING: Hemodialysis units. PATIENTS: One hundred ninety-two adult patients with end-stage renal disease on hemodialysis. INTERVENTION: An extended treatment period of sevelamer hydrochloride, preceded and followed by phosphate binder washout periods. MAIN OUTCOME MEASURES: Treatment-related changes in serum phosphorus, calcium, calcium x phosphate product, and PTH. RESULTS: Subjects treated with sevelamer alone, sevelamer with vitamin D metabolites (with or without calcium), and sevelamer with calcium without vitamin D experienced significant reductions in mean serum phosphorus (range, 2.1 to -2.9 mg/dL) and the calcium x phosphate product (range, -16.3 to -23.4 mg2/dL2). The mean serum calcium concentration increased in all subgroups except those treated with sevelamer alone (range, +0.3 to +0.5 mg/dL). In contrast, only subjects treated concurrently with vitamin D metabolites experienced a reduction in PTH. Subjects treated with sevelamer alone or sevelamer with calcium without vitamin D experienced an increase in PTH with treatment. CONCLUSION: Sevelamer hydrochloride is a safe and effective phosphate binder in hemodialysis patients. Sevelamer should be used in combination with vitamin D metabolites to jointly control hyperphosphatemia and hyperparathyroidism. Randomized clinical trials will be required to determine the optimal management strategies for metabolic bone disease in end-stage renal disease, as well as less advanced stages of chronic renal insufficiency.     

慢性阻塞性肺病急性发作期磷代谢的研究

对46例慢性阻塞性肺部疾病（COPD）急性发作期患者作血清和尿磷以及其它电解质、动脉血气分析、肾功能等生化指标测定。其中26例还作血清2、3-磷酸甘油酸（2、3-DPG），心动图超声等检查。发现低磷血症者14例，占30．4％；24小时尿磷减少者40例，占87．0％。左心功能，肾功能，肾磷阈值和2、3－DPG等指标，低磷血症组明显低于血磷正常组（P＜0．05）。对6例明显低血磷症者给予补磷（KH2PO420mmol／d），补磷后用力肺活量（FVC）比补磷前有明显增加（P＜0．05）。探讨影响COPD急性发作期患者低磷血症或磷缺乏的因素，认为以药物、肾功能、心功能和酸碱平衡紊乱的影响最大。     

Body composition changes in haemodialysis patients with secondary hyperparathyroidism after parathyroidectomy measured by conventional and vector bioimpedance analysis

Considering the negative effects of secondary hyperparathyroidism (SHPT) in patients with chronic renal failure (CRF), the objective of the present study was to evaluate body composition changes using conventional and vector bioimpedance analysis in patients before and after parathyroidectomy (PTX). Twelve adult patients, mean age 43.4 (sd 12.7) years, were evaluated prior to and 6 months after PTX. Diets were assessed with 3 d dietary records, and mean energy, protein, calcium and phosphorus intake were estimated from these inventories. Weight, height, BMI and bioelectrical impedance were measured; and biochemical markers of nutritional status (albumin and total protein) and bone metabolism (calcium, phosphorus and intact parathyroid hormone) were determined. No significant differences were observed in mean energy, protein and phosphorus after surgery. There was a significant increase in calcium intake after PTX (382.3 (sd 209.6) mg to 656.6 (sd 313.8) mg; P<0.05). Mean weight, BMI, conventional bioelectrical impedance measurements, total body fat, lean body mass and total body water were unaffected by surgery. However, the phase angle and reactance significantly increased after PTX (5.0 degrees (sd 1.4) to 5.6 degrees (sd 1.3); 44.1 (sd 15.6) Omega to 57.1 (sd 14.4) Omega, respectively). The high levels of intact parathyroid hormone before surgery had a negative effect on total body fat (r -0.69, P<0.05). After PTX, the mean albumin significantly increased (3.9 (sd 0.4) g/dl to 4.2 (sd 0.6) g/dl; P<0.05). PTX for SHPT is associated with certain changes in laboratory values, dietary intake and body composition. The latter is best seen with bioimpedance vector analysis.     

Myocardial calcification in chronic renal failure

The authors present the case of a young man who--as a consequence of chronic renal failure and long-term dialysis--developed a calcific cardiopathy. The myocardial calcification was proved histologically by light microscopy. They established that the calcification started in damaged myofibers and was principally caused by the secondary parathyroid hyperfunction. The diagnosis and therapy of the myocardial calcification is discussed on the basis of references. The prevention of this complication may improve the life-expectancy of patients treated by chronic dialysis.     

Role of low protein and low phosphorus diet in the progression of chronic kidney disease in uremic rats

Restriction of dietary protein is useful for chronic kidney disease (CKD) patients to protect residual renal function. However, the mechanism by which a low protein diet confers a beneficial effect in CKD patients remains unknown. One possibility is that the benefit from a low protein diet is associated with phosphorus restriction. The aim of this study is to compare the effect of protein and phosphorus on the progression of renal insufficiency using irreversible Thy1 rats, which histopathologically resemble IgA nephropathy. Irreversible Thy1 rats were fed six types of isocaloric diets consisting of three levels of protein (16.9, 12.6, and 8.4%) and two levels of phosphorus (0.5 and 0.3%) for 13 wk. Renal function was assessed biochemically and histopathologically. The low phosphorus (0.3%) diets showed protection of residual renal function regardless of dietary protein content in uremic rats. With the normal phosphorus (0.5%) diets, however, only the very low protein (8.4%) diet showed a beneficial effect, indicating that dietary phosphorus is a more important factor that affects the progression of renal insufficiency than dietary protein in this model. Furthermore, the low phosphorus diet also prevented an increase in serum parathyroid hormone, indicating that a low phosphorus diet might have beneficial effects not only for residual renal function but also for renal osteodystrophy, a typical complication of patients with CKD.     

A novel parathyroid hormone-related gene product

A parathyroid hormone-related protein (PTHrP) has been invoked as being responsible for the humoral hypercalcemia of malignancy. Eight of the first 13 amino acids of PTHrP are identical with those in PTH, but there is no other significant homology. The PTHrP gene is located on chromosome 12, whereas that for PTH is on chromosome 11, and the two genes are probably related by a duplication process. Antisera against PTHrP(1-34), which cross-react poorly or not at all with PTH, and antisera against other parts of PTHrP not homologous to PTH were used in immunocytochemistry using a peroxidase-antiperoxidase method, to identify PTHrP in the cytoplasm of cells in a series of unselected parathyroid adenomata. The study was based on our evidence that PTHrP is produced by fetal parathyroid and may be the predominant calcium-regulating hormone in the mammalian fetus. Glands from five patients with parathyroid hyperplasia secondary to chronic renal failure also stained positively for PTHrP. No evidence was obtained for PTHrP in sections from five patients with primary parathyroid chief cell hyperplasia or in a small group of patients with the multiple endocrine neoplasia type 1 or type 2 syndromes.     

Regression Equation Predicts Dietary Phosphorus Intake from Estimate of Dietary Protein Intake

Objective To develop a predictive equation for dietary phosphorus intake.

Design In this clinic-based, cross-sectional study, a dietitian-administered food frequency questionnaire provided dietary intake estimates for a population of patients with chronic renal failure. A prediction equation for dietary phosphorus intake was developed and was validated on another sample of patients with CRF from the same clinic.

Subjects Outpatients treated for chronic renal failure at the E. Wolfson Medical Center Institute of Nephrology in Holon, Israel, participated in the study (N=104, 73 men and 31 women, mean AGE=65.6 years). The validation sample consisted of 53 outpatients with chronic renal failure (38 men and 15 women, mean AGE=64.2 years) from the same clinic.

Main outcome measures Dietary variables (ie, energy, protein, carbohydrate, fat, phosphorus) were examined in terms of crude intake, as percentage of total energy intake, and per kilogram of body weight.

Statistical analyses performed Stepwise linear regression analysis and Student's t tests were used to examine relationships between dietary phosphorus and other variables. Results Dietary phosphorus (milligrams)=128+14 (protein intake [grams]) was the best-fitting equation and explained 84% of the variance in dietary phosphorus intake.

Applications The prediction equation for dietary phosphorus intake is especially useful for renal dietitians who calculate patient diets by hand. J Am Diet Assoc. 1996; 96:1268-1270.     

Assessing the Health Impact of Phosphorus in the Food Supply: Issues and Considerations

The Western dietary pattern of intake common to many Americans is high in fat, refined carbohydrates, sodium, and phosphorus, all of which are associated with processed food consumption and higher risk of life-threatening chronic diseases. In this review, we focus on the available information on current phosphorus intake with this Western dietary pattern, and new knowledge of how the disruption of phosphorus homeostasis can occur when intake of phosphorus far exceeds nutrient needs and calcium intake is limited. Elevation of extracellular phosphorus, even when phosphorus intake is seemingly modest, but excessive relative to need and calcium intake, may disrupt the endocrine regulation of phosphorus balance in healthy individuals, as it is known to do in renal disease. This elevation in serum phosphate, whether episodic or chronically sustained, may trigger the secretion of regulatory hormones, whose actions can damage tissue, leading to the development of cardiovascular disease, renal impairment, and bone loss. Therefore, we assessed the health impact of excess phosphorus intake in the context of specific issues that reflect changes over time in the U.S. food supply and patterns of intake. Important issues include food processing and food preferences, the need to evaluate phosphorus intake in relation to calcium intake and phosphorus bioavailability, the accuracy of various approaches used to assess phosphorus intake, and the difficulties encountered in evaluating the relations of phosphorus intake to chronic disease markers or incident disease.