高通量血液透析治疗老年尿毒症患者钙磷代谢异常的临床疗效

目的探讨高通量血液透析对老年尿毒症患者钙磷代谢异常的临床疗效。方法选取老年尿毒症患者钙磷代谢异常患者146例,随机数字表法分为观察组和对照组各73例。对照组给予低通量血液透析治疗,观察组给予高通量血液透析治疗,两组均治疗6个月。对两组治疗前后血磷、血钙、血肌酐及血甲状旁腺素水平变化及不良反应发生情况进行观察。结果治疗前两组患者血磷、血钙、血肌酐和血甲状旁腺素水平均无明显差异(P0.05),治疗后两组血磷、血钙、血肌酐和血甲状旁腺素水平差异显著(P0.05);治疗期间,两组患者均无明显不良反应发生。结论高通量血液透析可显著改善老年尿毒症患者钙磷代谢异常,无明显不良反应,安全有效,值得推广。     

慢性肺心病甲状旁腺素降钙素与钙磷镁代谢

慢性肺心病甲状旁腺素降钙素与钙磷镁代谢王方剑孙长贤吴凝萃曹岫岩我们检测了慢性肺心病患者血甲状旁腺素（ＰＴＨ）、降钙素（ＣＴ）、血钙（ＳＣａ）、磷（ＳＰ）、镁（ＳＭｇ）、２４小时尿钙（ＵＣａ）、磷（ＵＰ）、镁（ＵＭｇ）和肾功能，从ＰＴＨ和ＣＴ角度观察钙...     

2型糖尿病伴特发性甲状旁腺功能减退症一例

对一例T2DM伴严重低钙血症患者行甲状旁腺素(PTH),降钙素,1,25二羟维生素D_3[1,25(OH)_2D_3],24 h尿钙、磷检测及头颅CT检查。其24 h尿磷偏低,血PTH和1,25(OH)_2D_3下降,头颅CT示小脑和基底节区的双侧多发对称性钙化,明确诊断为特发性甲状旁腺功能减退症,经补充钙剂、骨化三醇、钾镁盐及其他综合治疗,患者症状改善,代谢指标控制良好。     

CaSR基因杂合突变致低尿钙性高钙血症一例报告

报告1例家族性低尿钙性高钙血症(familial hypocalciuric hypercalcemia, FHH)患者及其父母的临床资料。检测患者血清骨代谢相关指标：甲状旁腺素(parathyroid hormone, PTH)、血钙、血磷,24小时尿钙、24小时尿钙/尿肌酐清除率;并采集患者及父母外周血标本,提取基因组DNA,采用全基因外显子组测序检测先证者基因突变,并通过Sanger测序验证其家系的突变位点。发现患者血清钙增高、低尿钙,全外显子测序钙敏感受体基因第4外显子第659位G>A核苷酸杂合错义突变,导致其编码的第220位氨基酸由精氨酸变异为谷氨酰胺(R220Q)。其父母血钙检测值正常、无FHH相关临床症状及体征,Sanger测序验证其父母未检测到该位点突变。     

肺结核患者钙代谢的变化

肺结核患者钙代谢的变化姜全心李甲臣刘子英我们用放射免疫的方法，测定了肺结核患者血清甲状旁腺素（ＰＴＨ）、降钙素（ＣＴ）、骨钙素（ＯＳ）等钙调节激素以及２５－羟维生素Ｄ（２５－ＯＨ－Ｄ）的含量，观察了治疗前后血清及尿中钙（Ｃａ）、磷（Ｐ）、碱性磷酸酶（...     

1,25(OH)2D3对应用糖皮质激素治疗的肾病患者骨代谢的影响

目的观察1,25(OH)2D3对应用糖皮质激素治疗的原发性肾脏病患者骨代谢的影响。方法将16例原发性肾脏病患者随机分为治疗组和对照组。治疗组在应用糖皮质激素治疗的同时给予0.25μg的1,25(OH)2D3,每日1次口服,碳酸钙0.75,每日3次口服。对照组单纯给予碳酸钙0.75,每日3次口服。所有患者在治疗前及治疗12周时应用双能X线吸收法骨密度仪测定腰椎和股骨颈的骨密度,同时测定有关骨代谢指标,包括血全段甲状旁腺素,骨钙素,尿脱氧吡啶啉,血钙、磷以及血清白蛋白,24小时尿蛋白定量、尿钙和尿磷。结果治疗12周时两组患者的腰椎和股骨颈骨密度均下降,两组间比较无显著性差异(P>0.05);治疗12周时对照组患者的骨钙素较治疗前明显下降(P<0.05),而治疗组无明显差异;尿脱氧吡啶啉在两组中均下降,但治疗组下降明显(P<0.05);两组患者血全段甲状旁腺素、24小时尿钙和尿磷治疗前后及组间比较均无显著性差异(P>0.05);应用1,25(OH)2D3治疗者无1例出现高钙血症。结论应用糖皮质激素治疗12周的原发性肾脏病患者其腰椎及股骨颈骨密度下降明显。1,25(OH)2D3可促进骨形成,抑制骨的吸收。     

140例移植肾受者骨质丢失原因分析

目的研究调查移植肾受者骨密度并分析其主要影响因素。方法选取移植肾功能正常的受者140例,其中50例患者移植前检测血钙、磷、甲状旁腺激素、骨钙素、活性维生素D、尿钙和尿吡啶啉,双能X线吸收法测定腰椎和股骨近端骨密度。结果移植前患者钙、磷代谢异常明显,移植后血钙、磷、甲状旁腺激素、骨钙素、活性维生素D等均有明显改善,但尿钙／肌酐和尿吡啶啉／肌酐有增高趋势,股骨骨密度明显下降。平均每日激素用量为移植后尿钙／肌酐的主要预测因素。每日环孢素用量、体重指数与移植受者各部位骨密度明显正相关。累计激素用量是肾移植绝经女性病人腰椎和股骨颈骨密度的不良预测因素。结论患者肾移植后骨量减少和骨质疏松的发生率较高。骨质吸收增加可能是其主要原因。激素是移植。肾受者尤其绝经女性骨质吸收增加的主要因素之一。     

低钙腹透液对持续性腹膜透析患者高钙血症的影响

目的 观察低钙腹透液（PD4,钙离子浓度为1.25 mmol/L）对高钙血症持续性腹膜透析（CAPD）患者钙磷代谢的影响.方法 45例使用标准钙腹透液（PD2,钙离子浓度为1.75 mmol/L）后出现高钙血症的CAPD改用PD4透析,监测患者治疗前后血钙、磷、全段甲状旁腺激素（PTH）的变化,同时分析影响血钙水平变化的相关因素.结果 完成6个月观察的41例患者2个月后即出现血钙、磷水平明显降低,PTH较前明显升高（P＜0.05）.血钙下降幅度与患者的年龄呈负相关,而与透析剂量和超滤量呈正相关（P＜0.05）.结论 PD4可有效调节CAPD患者的高钙血症,缓解低转运性骨病的发生和发展.     

双手搐搦-低钙血症-肌酶升高

低钙性肌病是甲状旁腺功能减退症(以下简称甲旁减)的罕见并发症之一。本文报道了1例特发性甲旁减导致肌酸激酶(creatine kinase,CK)升高。患者为23岁男性,因间断双手搐搦10年入院,入院前2个月有一次癫痫样发作,实验室检查示血钙和甲状旁腺素水平降低,血清CK水平明显升高,给予钙剂及维生素D补充治疗后,随血钙水平上升,CK逐渐下降。本文同时对甲旁减合并肌酶升高的相关文献进行了复习和总结。     

老年男性骨质疏松患者阿仑膦酸钠治疗中血清骨保护素水平的变化

目的 观察阿仑膦酸钠治疗3年后骨密度、血清骨保护素(OPG)、相关骨代谢指标及性激素等的变化,探讨阿仑膦酸钠对老年男性骨质疏松患者的治疗作用及其OPG问可能的作用机制.方法 随机选取老年男性骨质疏松患者(骨质疏松组)72例及年龄匹配的健康对照者60例(对照组),检测血清OPG浓度.所有骨质疏松患者接受阿仑膦酸钠治疗3年,比较治疗前、后骨密度、血清OPG、性激素、血钙磷、甲状旁腺素、骨钙素、尿Ⅰ型胶原氨基端交联肽(NTX)、尿钙、尿肌酐等的变化. 结果 骨质疏松组血清OPG(10.56±2.56)pmol/L、骨钙素(9.54±4.40)tLg/L、甲状旁腺素(70.39±35.58)ng/L、尿NTX(72.06士9.78)nmol/L,高于对照组的OPG(8.91±2.20)pmol/L、骨钙素(6.77±2.87)μg/L,甲状旁腺素(47.11±21.80)ng/L,尿NTX(63.36±14.61)nmol/L(均为P<0.05或P<0.01).阿仑膦酸钠治疗后,骨密度明显上升,血清OPG降至(8.23±2.96)pmol/L,骨钙素降至(6.18±2.27)btg/L,甲状旁腺素降至(40.46±14.43)ng/L,尿NTX降至(64.83±11.40)nmol/L(均为P<0.05或P<0.01).Spearman相关分析显示治疗前、后骨密度的改变与OPG的变化有关. 结论 骨质疏松患者血清OPG水平明品高于对照组,阿仑膦酸钠治疗后随骨密度改善OPG浓度下降.阿仑膦酸钠能提高老年男性骨密度,改善骨代谢指标.     

Atherogenesis, calcium and calcium antagonists

Hyperchotesterolemia and arterial hypertension are highly interrelated risk factors of atherosclerosis. Early lesions in nonhuman primates with dietary hyperchotesterolemia resemble atherosclerotic lesions demonstrable in the arteries of American children with comparably elevated plasma cholesterol levels. Lesion formation depends upon calcium-regulated cellular processes such as chemotaxis, adhesion, migration, proliferation, lipid uptake and necrosis. Interventions acting on cell calcium uptake including treatment with calcium chelating agents, lanthanum trichloride, and calcium antagonists may retard atherogenesis in fat-fed animals in the absence of hypolipidemic effects. Recent controlled coronary angiographic trials in patients with coronary artery disease suggest that calcium antagonists may retard the progression of coronary atherosclerosis in humans. Large-scale long-term studies are needed to determine the utility of these agents for the treatment of coronary artery disease.     

Enhanced calcium bioavailability from a solubilized form of calcium citrate

An improved formulation of calcium citrate with higher aqueous solubility and bioavailability was sought. Mixtures of calcium hydroxide and citric acid, with a calcium to citrate molar ratio ranging from 0.67-1.5, dissolved rapidly in water, creating a metastably supersaturated solution. The presence of an excess of citrate in the mixture delayed the precipitation of calcium citrate and kept calcium in solution longer. Thus, the mixture with a calcium to citrate molar ratio of 1.25, containing 500 mg elemental calcium, dissolved in 300 mL water within 2 min and could be kept in solution for 1 h at a wide pH range between 2 and 7. Intestinal calcium absorption, measured from the increment in urinary calcium during the second 2 h following an oral calcium load (500 mg) in 15 normal subjects was significantly higher from the mixtures (calcium to citrate molar ratios of 1.5 and 1.25) than from tricalcium dicitrate. The fractional calcium absorption, obtained from fecal recovery of radiocalcium after oral administration of 500 mg calcium prelabeled with 47Ca in 11 normal subjects, was also higher for the mixture with a calcium to citrate molar ratio of 1.25. The most efficient calcium absorption was obtained with the mixture of calcium hydroxide and citric acid with a calcium to citrate molar ratio of 1.25. The increment in urinary calcium after an oral load with this mixture was 62.4% greater than that obtained with tricalcium dicitrate [0.138 +/- 0.056 (+/- SD) vs. 0.085 +/- 0.086 mg/dL glomerular filtrate; P less than 0.05]. The fractional calcium absorption was 88.4% higher (0.324 +/- 0.107 vs. 0.172 +/- 0.061; P less than 0.05). This mixture provided the highest concentration of ionic calcium, indicating that calcium (rather than calcium-citrate complex) is the fraction absorbed from the intestinal tract. This study, therefore, suggests that a liquid calcium preparation formulated from the mixture of calcium hydroxide and citric acid is more effective than a solid preparation of tricalcium dicitrate in providing soluble and bioavailable calcium.     

Classification of calcium channels and calcium antagonists: Progress report

Summary The molecular biology and electrophysiology of calcium channels is proceeding apace, partially driven by the clinical success of the drugs classed as “calcium antagonists”. Indeed, there are now more than 70 drugs in development that have been claimed to be “calcium antagonists” of one type or another. In order to ensure that there is a logical nomenclature for the channels and the drugs acting at the channels, an international committee has met over the last 2 years to classify the channels and the drugs. This report consists of an overview of current thinking, which will be finalized in a document submitted to the IUPHAR (International Union of Pharmacologists) nomenclature committee.     

Calcium bioavailability from calcium carbonate and calcium citrate

Fourteen normal subjects took 1000 mg calcium orally as calcium citrate or calcium carbonate. The amount of calcium absorbed was estimated from the rise in urinary calcium. The urinary calcium following calcium citrate load significantly higher (by 20-66%), whether expressed as the total amount or as the increment above basal (fasting) excretion. Thus, calcium citrate provides a more optimum calcium bioavailability than calcium carbonate.