低钙透析液对血液透析伴继发性甲状旁腺功能减退患者的临床研究

目的：探讨应用含钙1.25mmol／L浓度透析液进行血液透析对维持性血液透析（MHD）伴相继发性甲状旁腺功能减退患者的钙磷代谢和甲状旁腺功能的影响。方法：选择MHD6个月以上、病情稳定、连续2次血iPTH〈100pg／ml的患者60例,随机分为对照组（含钙1.5mmol／L透析液）和治疗组（含钙1.25mmol／L透析液）,每组各30例,观察时间6个月。观察并记录研究前、研究后l、3、6个月等不同时期患者血iPTH、血清校正钙、磷、钙磷乘积等指标的变化以及相关不良反应。另外,选择使用含钙浓度1.5mmol／L和1.25mmol／L透析液进行MHD的患者各20例,检测单次透析前、透析结束时以及下次透析前的血清校正钙、磷和iPTH浓度。结果：（1）治疗组单次透析后血清校正钙、磷和钙磷乘积均较透析前明显下降,iPTH浓度较透前明显升高,P〈0.01;而对照组上述血钙和iPTH浓度无明显变化;（2）透析后治疗组血清校正钙和钙磷乘积较对照组明显下降,血iPTH浓度较对照组明显升高,P〈0.01;两组血磷浓度差异无统计学意义。（3）治疗组1个月后血清校正钙、磷和钙磷乘积较治疗前开始下降,3个月后进一步下降,P〈0.05,6个月后各项指标趋于稳定;iPTH水平1个月后较治疗前明显升高,并随着治疗时间的延长,逐渐升高,P〈0.01。（4）对照组治疗后1、3、6个月上述指标与治疗前比较差异无统计学意义。（5）两组透析过程中出现的不良反应差异无统计学意义。结论：对于血iPTH〈100pg／ml MHD患者应用含钙1.25mmol／L透析液进行血液透析能较好地控制其血清校正钙、磷、钙磷乘积水平,有效地改善被过度抑制的甲状旁腺功能,并且安全性良好。     

低钙透析液治疗对维持性血液透析期间高血压患者的影响

目的：观察低钙透析治疗对维持性血液透析（ MHD）期间高血压患者的影响。方法：将61例维持性血液透析期间合并高血压的患者分为两组,对照组30例,为常规钙透析液组（1.75%）;治疗组31例,为低钙透析液组（1.25%）;记录患者在透析前及透析结束并静息30 min后的血压,研究期间对透析液钙离子浓度进行监测。在研究开始前及开始后对患者透析前后血钙及血磷情况每月进行检测,观察有无严重钙磷代谢紊乱情况,研究前后检测患者透析前后甲状旁腺激素（ PTH）水平。结果：不同透析液钙离子浓度对MHD期间血压的影响：两组治疗前,其收缩压及舒张压分别比较,差异无统计学意义（P〉0.05）;经过3个月的治疗观察,治疗组与对照组治疗后收缩压比较（134±13.2 vs 150±19.5）,P〈0.05,且舒张压比较（77±15.7 vs 89±19.2）,P〈0.05,说明不同透析液钙离子浓度对MHD期间高血压具有一定的治疗作用。不同透析液钙离子浓度对钙磷及PTH水平的影响：两组治疗前,其血钙、血磷及PTH分别比较,差异无统计学意义（P〉0.05）;经过3个月的治疗观察,治疗组与对照组治疗后血钙比较（1.9±0.13 vs 1.8±0.15）,P〉0.05;血磷比较（1.92±0.89 vs 1.89±0.99）,P〉0.05;PTH比较（267±44 vs 260±53）,P〉0.05,说明不同透析液钙离子浓度对MHD期间钙磷代谢及PTH水平无明显的影响。结论：低钙透析治疗对维持性血液透析（ MHD）期间高血压具有一定的治疗作用。     

低钙透析液对血液透析患者生活质量的影响

目的探讨低钙透析液（LCD）对维持性血液透析（MHD）患者生活质量（OOL）的影响。方法将30例血清矫正钙≥2．37mmol／L的MHD患者依据血甲状旁腺激素（iPTH）水平分为3组,均使用LCD透析3个月,比较3组患者使用LCD透析前后SF-36问卷评分值及血清钙、磷、钙磷乘积、iFrrH、骨钙素（BGP）水平。结果①透析后与透析前相比,Ⅰ组患者SF-36总分、生理健康总分（PCS）、生理功能、躯体职能（RP）、躯体疼痛（BP）及情感状况评分增高（P〈0．05）,总体健康、生命活力、社会功能及精神健康无差异;Ⅱ组患者PCS、RP和BP评分降低（P〈0．05）,余指标无差异;Ⅲ组各指标评分均无差异（P〉0．05）。②与透析前相比,Ⅰ、Ⅱ组患者透析后血清钙和钙磷乘积均降低（P〈0．05）,iPTH和BGP水平均升高（P〈0．05）;Ⅲ组无变化。结论LCD短期应用能显著提高无动力型骨病患者生活质量,尤其减轻躯体疼痛,长期使用可能影响患者生理健康从而对QOL产生负影响,LCD对MHD患者心理健康无明显改善。     

不同钙离子浓度透析液对单次血液透析钙平衡的影响

目的观察三种不同钙离子浓度透析液对维持性血液透析患者单次透析过程中血钙的影响,为透析液钙离子浓度的个体化选择提供理论参考。方法选择2014年1月在哈尔滨医科大学附属第一医院血液净化中心接受维持性血液透析治疗的患者80例为研究对象,随机分为3组,根据使用不同钙离子浓度分别为1.25 mmol/L(DCa 1.25组)、1.5 mmol/L(DCa 1.50组)和1.75 mmol/L(DCa 1.75组)的透析液进行单次血液透析治疗,每次透析4 h,3组所用透析液除钙离子浓度不同外,其他透析液主要成分组间无差别。分别检测每组透析前、后及下一次透析前的血肌酐(SCr)、尿素氮(BUN)、血白蛋白(albumin,Alb)、血钙、血磷等生化指标,同时监测单次透析前后患者的血压变化。结果对患者透析前基线数据初步分析结果表明,透析前iPTH水平为(458.7±408.2)ng/L、血钙(2.2±0.2)mmol/L、血磷(2.1±0.6)mmol/L、钙磷乘积(57.4±18.9)。iPTH、血钙、血磷达标率分别为53.8%、46.3%,25.0%;透析患者普遍伴有低钙血症(占48.8%)、高磷血症(占71.3%)和高甲状旁腺素血症(占23.8%)。单次透析治疗结束后的血钙水平分别为DCa 1.25组(2.27±0.20)mmol/L、DCa 1.50组(2.53±0.21)mmol/L、DCa 1.75组(2.51±0.20)mmol/L,组间比较差异有统计学意义(F=12.52,P0.01)。与透析前相比较,3组透析后血钙浓度较透析前均有所增加;协方差分析结果表明,在扣除透析前血钙浓度的影响因素后,DCa 1.25组血钙平均增加量最小。单次透析结束后血钙达标率分别为65.4%(DCa 1.25组)、48.1%(DCa 1.50组)、58.8%(DCa1.75组);透析结束后高钙血症的发生率DCa 1.75组(占41.2%)与DCa 1.50组(占51.9%)明显高于DCa 1.25组(占19.2%)。三种透析液对透析患者的血磷、血压影响差异均无统计学意义(P0.05)。结论单次使用钙离子浓度为1.25 mmol/L的透析液治疗,对透析后血钙浓度的影响最小、血钙达标率最高、高钙血症的发生率最低;与钙离子浓度分别为1.50 mmol/L和1.75 mmol/L透析液比较,钙离子浓度1.25 mmol/L更接近人体生理离子钙浓度。     

不同钙浓度透析液对血液透析患者钙磷代谢的影响

终末期肾衰竭伴有甲状旁腺功能亢进患者常常使用大剂量含钙的磷结合剂，应用高钙（1．75mmol／L）透析液等治疗，导致钙负荷增高，引起软组织、血管和心脏钙化，增加患者死亡率。孙鲁英等曾报道单次使用低钙（1．25mmol／L）透析液的疗效，但长期使用低钙透析对患者的影响报道甚少。为此，我们连续6个月分别使用两种钙浓度的透析液，观察其对患者血压、钙、磷和PTH的影响。     

甲状旁腺切除术后长期低甲状旁腺素对维持性血液透析患者骨代谢和血管钙化的影响

目的:观察维持性血液透析(maintenance hemodialysis,MHD)患者甲状旁腺切除术(parathyroidectomy,PTX)术后长期低甲状旁腺素患者骨代谢指标的变化和腹主动脉钙化的关系.方法:回顾性分析12例PTX术后完成2年随访的MHD患者,满足PTX术后6月开始持续血全段甲状旁腺素(inta...     

不同钙离子浓度透析液对血液透析患者钙平衡及甲状旁腺素的影响

目的研究不同钙离子浓度透析液对维持性血液透析(MHD)患者透析过程中钙平衡及全段甲状旁腺激素(iPTH)的影响,为透析患者个体化选择透析液钙离子浓度提供理论依据.方法 12例血钙正常的稳定的MHD患者分别使用钙离子浓度为1.25 mmol/L(DCa1.25)、1.5mmol/L(DCa1.5)和1.75 mmol/L(DCa1.75)的透析液进行血液透析(透析液其他成分不变),每次透析4 h.检测透析前后血清总钙(tCa)、离子钙(iCa)、iPTH及透析废液的iCa和磷(P),并对血压进行监测.结果使用DCa1.25时,患者体内丢失的钙平均为5.03mmol,但透后血iCa和tCa浓度与透前相比无明显变化,iPTH透后较透前显著升高(P＜0.05).使用DCa1.5时,患者体内钙的蓄积平均为1.4 mmol,透后血iCa和tCa浓度与透前相比明显升高(P＜0.01),其中25%的患者发生透后高血钙,iPTH较透前无明显变化;使用DCa1.75时,患者体内钙的蓄积平均为3.3 mmol,透后血iCa和tCa浓度比透前明显升高(P＜0.01),其中83.3%的患者发生透后高血钙,iPTH较透前明显降低(P＜0.01).3种透析液对血磷的清除无明显差异(P＞0.05).结论对于透前血钙水平正常的患者,DCa1.75的透析液明显增加了患者的钙负荷,增加了透后高钙血症的发生.DCa1.25的透析液能够明显减轻钙负荷,但长期使用应注意监测iPTH水平.对于透前轻度低血钙或在正常值低限的患者,DCa1.5的透析液是适用的,如果发生透后高钙血症,则应改用DCa1.25的透析液.     

不同钙浓度透析液治疗甲状旁腺切除术后低钙血症的探讨

目的观察血液透析患者行甲状旁腺切除术后,使用不同钙浓度透析液纠正术后低钙血症的效果。方法回顾性分析2011年10月至2014年5月我院血液透析中心行甲状旁腺切除术的13例患者,根据术后透析治疗时使用的不同钙浓度透析液,分为A组(使用钙浓度1.50 mmol/L透析液)5例,B组(使用钙浓度1.75 mmol/L透析液)8例。分别观察2组患者术后当日、术后第3、6个月透析前后的血压及透析间期的血钙、血磷、全段甲状旁腺素(intact parathyroid hormone,iPTH),比较数值之间的变化;同时统计2组患者口服钙剂的用量,并通过彩色多普勒超声心脏瓣膜评估及胸部多层螺旋电子计算机断层扫描成像(multi-slice computed tomography,MSCT)所示心脏大血管的影像学表现,比较术前及术后第6个月患者冠状动脉钙化评分分值的变化。结果比较2组单次血液透析治疗时透析前与透析结束后4 h的血钙,2组透析结束后4 h的血钙较透析前均升高,差异有统计学意义(P0.05)。同时分别比较2组透析前与术后第3、6个月时血钙变化,差异有统计学意义(P0.05)。而2组之间透析前的血磷、iPTH无统计学差异(P0.05)。通过6个月调整治疗后,血钙较术后当日明显升高(P0.05),血磷明显下降(P0.05)。术后第6个月时,B组较A组口服钙片的剂量明显减少,血压明显上升(P0.05)。同时术前及术后第6个月心脏瓣膜评估及冠状动脉钙化评分分值无明显变化(P0.05)。结论高钙透析液能更好、更快的纠正术后出现的严重低钙血症,减少维持性钙片的服用剂量,但须注意异位钙化的风险及高血压的发生。     

不同钙浓度腹膜透析液对长期CAPD患者矿物质和骨代谢影响的分析

目的观察腹膜透析液钙离子浓度对持续性不卧床腹膜透析(CAPD)患者矿物质和骨代谢的影响。 方法回顾性分析我院腹膜透析中心行CAPD治疗2年以上的123例患者,根据腹膜透析液钙离子浓度分为低钙腹膜透析液组(LCD组,钙离子浓度为1.25 mmol/L)和标准钙腹膜透析液组(SCD组,钙离子浓度为1.75 mmol/L),观察不同钙浓度腹膜透析液对患者血清钙、磷、全段甲状旁腺激素(iPTH)、颈动脉厚度、心脏瓣膜钙化及骨痛、皮肤瘙痒等情况的影响。使用SPSS 18.0统计软件包进行数据处理。 结果2组患者治疗前人口学特征、腹膜转运特性、钙磷代谢等指标的基线水平差异无统计学意义(P>0.05)。治疗2年后,2组患者血钙浓度及达标率较治疗前均显著增高(P<0.05),SCD组血钙浓度增幅高于LCD组,但差异无统计学意义(0.26±0.31 mmol/L与0.17±0.29 mmol/L, t＝1.621,P＝0.108);2组间治疗后血清钙、磷、iPTH平均水平及其达标率、颈动脉厚度、心脏瓣膜钙化比例、骨痛及皮肤瘙痒累计发生率差异均无统计学意义(P>0.05);LCD组活性维生素D使用比例显著高于SCD组(χ² ＝6.373,P<0.05)。 结论采用低钙与标准钙腹透液治疗2年,对CAPD患者矿物质和骨代谢的影响无显著性差异。     

低钙透析液用于血液透析的临床观察

目的 探讨低钙透析液用于血液透析的有效性及安全性.方法 采用稀释后浓度为1.25 mmol/L碳酸低钙透析液,常规透析治疗24例高钙血症血液透析患者的规律.观察高钙血症血液透析患者在应用碳酸低钙透析液3、6个月后血钙、钙磷乘积、全段甲状旁腺激素的指标变化及不良反应.结果 经治疗后发现血钙下降水平与低钙透析液使用前比较差异有统计学意义(P＜0.05);钙磷乘积比较差异也有统计学意义(P＜0.05);血磷与全段甲状旁腺激素比较差异无统计学意义(P均＞0.05).结论 高钙血症的血液透析患者在使用低钙透析液后,血钙下降明显、可有效降低钙磷乘积,可能有益于减轻血液透析患者骨外转移性钙化的发生.

Abstract：

Objective To investigate the clinical effect of low-calcium dialysate in the treatment of the hypercalcemia of hemodialysis patients. Methords Low-calcium dialysate ( 1.25mmol/L) was used in 24hemodialysis patients of Hypercalcemia. Results There were significant difference between low-calcium dialysate was used before and after three months and six months in blood calcium( P ＜ 0.05), and there were also significant difference in Ca × iP ( P ＜ 0.05). There were no singnificant difference in blood phosphorus ( P ＞ 0.05) and in iPTH ( P ＞ 0.05) Conclusion There were significant difference between low-calcium dialysate was used before and used after three months and six months in blood calcium with hypercalcemia. It is effect to reduced calcium transfer from body's bone to other body's organs.     

低钙透析液对血液透析患者钙磷代谢及骨质重塑的影响

目的比较低钙透析液对长期血液透析患者钙磷代谢及骨重塑的影响。方法45例血清矫正钙≥9.5mgdl且iPTH≤150pgml患者随机分为透析液钙浓度1.25、1.5及1.75mmolL3组透析治疗3个月,观察3组患者血清Ca、P、Ca×P、iPTH、BGP、IGF1及IGFBP3水平差异。结果观察结束时,DCa1.5与DCa1.75组,血清Ca×P水平DCa1.5组无变化、DCa1.75组升高(P<0.05),IGF1水平2组均保持稳定;iPTH及BGP水平DCa1.5组升高(P<0.05)及DCa1.75组降低(P<0.05)。DCa1.25组血清Ca×P及IGF1水平明显降低(P<0.01),iPTH及BGP水平有显著升高(P<0.01)。透析前血清iPTH及BGP水平呈正相关(r=0.155,P<0.05)。结论低钙透析液可在有限时间内有效降低钙负荷及改善骨代谢。长期应用低钙透析液很可能通过增加iPTH、BGP水平及降低IGF1水平引发骨质疏松。     

Effects of low dialysate calcium concentration on health-related quality of life in hemodialysis patients

Background A dialysate calcium concentration of 2.5 meq/l (1.25 mmol/l) is currently recommended, but there are not enough studies to examine the effects of this calcium concentration on clinical outcomes. We explored the effects of this calcium concentration on health-related quality of life (HRQOL) in hemodialysis patients.Methods The dialysate calcium concentration was lowered from 3.0 meq/l to 2.5 meq/l in 78 hemodialysis patients. The Medical Outcomes Study (MOS) Short Form 36 (SF-36) norm-based scores, the doses of recombinant human erythropoietin (rHuEpo), and the serum levels of corrected calcium, phosphorus, intact parathyroid hormone (i-PTH), and hemoglobin were compared at baseline and 8 months after the change of dialysate calcium concentration.Results Seventy-three patients completed the study. Mean changes in SF-36 scores were: physical functioning, −2.4; role physical, −3.9; bodily pain, −3.4; general health perception, −1.5; vitality, −2.2; social functioning, −1.9; role emotional, −2.0; mental health, −2.0. The declines of scores for role physical and bodily pain were significant. Serum i-PTH levels increased significantly, from 212 pg/ml to 278 pg/ml, while the doses of rHuEpo and serum levels of corrected calcium, phosphorus, and hemoglobin did not change significantly.Conclusions A dialysate calcium concentration of 2.5 meq/l was not shown to have positive effects on HRQOL.     

Correlation of vitamin D,bone mineral density and parathyroid hormone levels in adults with low bone density

Background:

Bone mineral densiy (BMD) is known to be affected by serum 25-hydroxyvitamin D (25(OH) D) levels, intact parathyroid hormone (iPTH) levels. Indian data pertinent to above observation is scant. Our study aimed to investigate the relationships between serum 25-hydroxyvitamin D (25(OH) D) levels, intact parathyroid hormone (iPTH) levels and bone mineral density (BMD) in a cohort of Indian patients.

Materials and Methods:

Adults with or without fragility fractures with low BMD at the hip or lumbar spine were evaluated clinically along with laboratory investigations. T-scores of the hip and spine were derived from BMD-DEXA (dual-energy X-ray absorptiometry). Multivariate regression models were used to investigate the relationships between serum 25(OH) D, iPTH and BMD.

Results:

Total of 102 patients (male:female = 38:64) with a mean age of 62.5 ± 6.4 years were included in the study. Forty-four patients had osteopenia. Osteoporosis was present in 58 patients. The mean values for serum 25(OH) D and iPTH levels were 21.3 ± 0.5 ng/ml and 53.1 ± 22.3 pg/ml, respectively. In 84.3% of patients, serum 25(OH) D levels were below 30 ng/ml (Normal = 30-74 ng/ml), confirming vitamin D deficiency. There was no association between 25(OH) D levels and BMD at the hip or lumbar spine (P = 0.473 and 0.353, respectively). Both at the hip and lumbar spine; iPTH levels, male gender, body mass index (BMI) and age were found to be significant predictors of BMD. Patients with higher BMI had significantly lower BMD and T-score. At levels <30 ng/ml, 25(OH) D was negatively associated with iPTH (P = 0.041).

Conclusion:

Among our cohort of patients with low BMD, no direct relationship between serum 25(OH) D levels and BMD was observed. However, a negative correlation between iPTH and 25(OH) D at serum 25(OH) D concentrations <30 ng/ml. Serum iPTH levels showed a significant negative association with BMD at the hip and lumbar spine. Our findings underscore the critical role of parathyroid hormone in bone metabolism and health.     

低钙透析液对腹膜透析患者钙磷代谢的影响

目的横断面研究腹膜透析患者使用低钙透析液的安全性及其影响因素。方法选择西安交通大学医学院第一附属医院肾脏内科腹膜透析超过6个月的患者共39例，其中男24例，女15例，年龄56．49±19．31岁，其中使用常规（ca 1．75mmol／L）透析液8例，低钙（ca 1．25mmol／L）透析液31例，比较两组血清钙、磷、甲状旁腺激素、血压以及使用碳酸钙的情况。结果两组血钙无明显差异；常规透析液组血磷和钙磷乘积高于低钙组，两组iPTH无明显差异。低钙组服用碳酸钙剂量明显高于常规透析液组。低钙组服用碳酸钙与未服用碳酸钙血钙无明显差异，服用碳酸钙组血磷控制较为理想、钙磷乘积更接近正常，未服用碳酸钙组血PTH明显升高。结论腹膜透析患者使用低钙透析液有利于控制血磷和血压，有效预防钙磷乘积升高。提高对碳酸钙的依从性是预防使用低钙透析液后引起继发性甲状旁腺功能亢进的关键。     

High-normal calcium (1.35 mmol/I) dialysate in patients on CAPD: efficient and safe long-term control of plasma calcium, phosphate, and parathyroid hormone

AIM.: The aim of the present study was to examine the long-term efficacyand safety of treatment with a high-normal calcium dialysatewith a calcium concentration of 1.35 mmol/l in patients on CAPD.This dialysate calcium concentration is close to the high-normalplasma ionized calcium level aimed at in dialysis patients inorder to suppress the parathyroid hormone secretion. The end-pointsof the study were (1) plasma ionized calcium (iCa) and phosphate(P) levels, (2) plasma intact parathyroid hormone (PTH) levels,(3) doses of calcium carbonate and alfacalcidol, (4) requirementsof Al-containing phosphate binders, and (5) bone mineral density(BMD). RESULTS.: Thirty-seven non-selected patients on CAPD treatment were followedfor an average of 10 months after switching from a dialysateCa of 1.75 to 1.35 mmol/l. After 1 week, a significant decreaseof mean iCa from 1.26±0.01 to 1.23±0.01 mmol/l(P<0.05) and an increase of median PTH from 80 to 135 pg/ml(P<0.01) were seen. From the 2nd week and onwards, however,basal levels of iCa and PTH were restored and remained stable.Mean plasma iCa was kept within 1.23–1.31 mmol/l; meanplasma P below 1.65 mmol/l and median PTH within 52–135pg/ml. Episodes of hypercalcaemia were few (1.2 cases of plasmaiCa>1.45 mmol/l per 100 treatment weeks), and the need forAl-containing P binders low with only five patients requringthis treatment for isolated and four patients for repeated episodesof hyperphosphataemia or hypercalcaemia. After switching froma dialysate Ca of 1.75 to 1.35 mmol/l, the doses of calciumcarbonate and alfacalcidol could be significantly increased.Furthermore, using the dialysate Ca of 1.35 mmol/l made it possibleto induce a controlled increase of PTH levels to 80–100pg/ml by a temporarily discontinuation of alfacalcidol and/ora reduction of calcium carbonate dosage in the patients wherePTH had become suppressed to levels below the upper normal limit.The intention of the treatment was to maintain PTH levels within1.5–2.5 times the upper normal limit for non-uraemic patients.Pre-study BMD of the vertebral bodies L2–L4 and of thefemoral neck were normal and not significantly different frompost-study measurements. CONCLUSIONS.: The present study demonstrated that when using a high-normaldialysate Ca concentration of 1.35 mmol/l in non-selected patientson CAPD treatment, high-normal plasma iCa and near-normal plasmaP levels could be readily achieved with a minimal risk of incidentalhypercalcaemia despite use of calcium carbonate as the mainP binder. As a consequnce of the tight Ca and P regulation,minimal doses of alfacalcidol were required to keep PTH withinacceptable limits. We recommend this dialysate Ca concentrationas a first-choice therapy for the majority of patients startingon CAPD treatment.     

人甲状旁腺素(1-34)对新生鼠成骨细胞钙含量及钙化结节形成的影响

目的研究外源性ｈＰＴＨ（１－３４）对新生大鼠成骨细胞基质钙含量及钙化结节形成的影响。方法新生大鼠成骨细胞原代培养,原子吸收分光光度法测细胞基质钙含量,ｖｏｎＫｏｓｓａ染色鉴定钙化结节。结果１０－１０～１０－７ｍｏｌ·Ｌ－１ｈＰＴＨ（１－３４）持续作用于细胞,基质钙含量与对照相比显著降低;１０－８ｍｏｌ·Ｌ－１ｈＰＴＨ（１－３４）在以４８小时为一循环的前１２小时给药循环８次时基质钙含量达最高峰,与对照组相比增加５７６％,且形成钙化结节最多。结论ｈＰＴＨ（１－３４）刺激成骨细胞基质钙含量及钙化结节形成与给药方式及药物浓度有关,低浓度间歇性给与ｈＰＴＨ（１－３４）能提高成骨细胞基质钙及促进钙化结节形成。     

Natural history of parathyroid function and calcium metabolism after kidney transplantation: a single-centre study.

BACKGROUND: The natural history of parathyroid function after successful renal transplantation (RT) and the factors predisposing to persistent hyperparathyroidism (HPT) are not well established. A better knowledge of these data may be helpful in the development of algorithms for optimal surveillance and treatment of HPT after successful RT. Our aim was to evaluate the post-transplant natural history of parathyroid function and calcium metabolism in patients with a functional renal graft and to identify risk factors for persistent HPT. METHODS: Charts of 1165 allograft kidney recipients transplanted between 1989 and 2000 were reviewed. Patients with an intact parathyroid hormone (iPTH) level available at the time of transplantation were identified. The charts of the latter patients were checked for a variety of demographic and clinical data, and all determinations of the iPTH concentration available since transplantation were recorded. Serum levels of calcium, phosphorus, alkaline phosphatases and creatinine, concurrently determined, were also registered. RESULTS: After an initial fall, iPTH levels showed a slow but steady decline towards the upper normal limit. The prevalence of persistent HPT, defined as an iPTH level > or =2.5 times the upper normal limit or the need for parathyroidectomy following transplantation, remained stable at approximately 17% up to 4 years after transplantation. Patients with persistent HPT had significantly elevated serum levels of iPTH, calcium and phosphorus at the time of RT, and had spent a longer time on dialysis. Post-transplant iPTH levels correlated significantly with transplant kidney function. CONCLUSION: Kidney transplant recipients with a high iPTH and calcium x phosphate product at the time of transplantation are at risk for persistent HPT especially when renal function is suboptimal. Therapy for persistent HPT, if considered, should be initiated 3 months post-transplantation since further spontaneous improvement of parathyroid function thereafter is limited.