维持性血液透析患者全血微量元素与甲状旁腺激素水平的相关性分析

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者血清甲状旁腺激素(parathyroid hormone,PTH)与全血微量元素之间的关系. 方法 采用单中心横断面研究,纳入2019年9月在暨南大学附属广州红十字会医院血液透析中心行MHD的患者.记录患者临床资料、用药情况,测定透...     

Effects of high phosphate and low calcium on the hyperplasia of normal rat parathyroid in vitro

Objective To explore the effects of high phosphate and low calcium on the secretion function and cell proliferation in normal rat parathyroid tissues. Methods The rat parathyroid tissues resected by surgical operation under dissection microscope were incubated in vitro for 5 days and were treated with high phosphate or low calcium medium on the second day and the third day after incubation. The cell apoptosis at different time points was measured by flow cytometry.The levels of intact parathyroid hormone (iPTH) in the supernatant at different time points were detected by ELISA. The mRNA levels of prepro-PTH and proliferating cell nuclear antigen (PCNA) were measured by real-time PCR, while the protein levels of PCNA after the 24-hour treatment with high phosphate or low calcium medium were measured by Western blotting. Results Flow cytometric analysis showed that the percentage of normal living cells on the first day and the second day after incubation was significantly higher than that on the third day to the fifth day after incubation in the rat parathyroid tissues (all P﹤0.05), and there was no statistical difference among that on the third day to the fifth day after incubation. There was no significant difference in cell survival rates on the first day to the fifth day after incubation (all﹥85%) under normal or high phosphate medium. There was no significant difference in the daily iPTH level on the first day to the fifth day after incubation under normal medium. Compared with normal medium, the iPTH level in the supernatant under high phosphate medium increased (P﹤0.05), and the expressions of preproPTH mRNA and PCNA in parathyroid tissues were significantly up-regulated (both P﹤0.05) after the 24-hour treatment with high phosphate medium. Compared with normal medium, the iPTH level in the supernatant under low calcium medium increased (P﹤0.05), and the expression of preproPTH mRNA in parathyroid tissues was significantly up-regulated after the 24-hour treatment with low calcium medium (P﹤0.05). Conclusions It is feasible to incubate the parathyroid issues from rats in vitro, and the best incubation time should be within 2 days. Low calcium and high phosphate stimulation could increase the synthesis and secretion of PTH, while high phosphate can also promote the cell proliferation, which is an important factor for the regulation of parathyroid function in physiological state.     

维持性血液透析患者血管钙化及相关因素分析

目的观察维持性血液透析(MHD)患者血管钙化情况及其影响因素,探讨矿物质与骨代谢指标在MHD患者血管钙化中的作用。方法选取MHD患者69例和健康体检者67例,检测血清白蛋白、血清总钙、血磷、血肌酐、碱性磷酸酶、钙磷乘积和全段甲状旁腺激素(i PTH)。同时行侧位腹平片(空腹)、髋关节正位片、双手及腕关节正位片X线检查以评价腹主动脉、股动脉、桡动脉及双手动脉钙化情况,并了解钙化与相关因素之间的关系。结果 MHD组血管钙化程度明显高于正常对照组(P0.05);中重度钙化组年龄、透析时间、血糖、血磷和钙磷乘积均高于轻度钙化组(P0.05);低i PTH(150 ng/L)、高i PTH(300 ng/L)患者i PTH与钙化相关(P0.05),150~300 ng/L i PTH患者i PTH与钙化无相关性(P0.05)。结论年龄、透析时间、血磷、血糖、钙磷乘积、i PTH水平可能与MHD患者血管钙化密切相关。     

Primary Hyperparathyroidism Masquerading as Rickets: Diagnostic Challenge and Treatment Outcomes

Primary hyperparathyroidism (PHPT) is extremely uncommon among children and is more likely to be associated with genetic syndromes, multiglandular involvement, and more severe symptoms. Rickets can very rarely be the presenting feature of PHPT in children. Rickets was diagnosed in a 12-year-old girl presenting with short stature, genu valgum, eversion deformity at the ankle joints, and flat feet. Radiograms showed generalized osteopenia, widening of the distal ends of the long bones along with splaying, cupping and fraying. Biochemical evaluation revealed low serum calcium (7.8 mg/dL), low phosphorus (1.4 mg/dL), vitamin-D deficiency [25-hydroxy-vitamin-D (25(OH)D): 8.7 ng/mL], and elevated intact parathyroid hormone (PTH, 811 pg/mL). Re-evaluation due to lack of clinical improvement following vitamin-D and calcium supplementation revealed hypercalcemia 11.9 mg/dL, normal 25(OH)D 41 ng/mL, persistence of elevated PTH 632 pg/mL. A 99mTc-sestamibi scan showed increased uptake at the lower pole of the right lobe of the thyroid. A right inferior parathyroidectomy was performed. Histopathology revealed chief cell type parathyroid adenoma. Last evaluated 4 months after surgery, the bone pains and proximal weakness had resolved, with significant improvement in the patient’s quality of life. Rickets in the setting of PHPT often masks the classical phenotype of PHPT. In a child with rickets, lack of improvement following vitamin-D supplementation, hypercalcemia at presentation or following vitamin-D supplementation are warning signs which necessitate further evaluation to rule out PHPT.Conflict of interest:None declared.     

严重急性呼吸综合征患者血清甲状腺和甲状旁腺激素水平观察及评价

目的　观察和评价SARS患者血清甲状腺素和甲状旁腺素含量变化。方法 用电化学发光法检测了 48例SARS患者血清甲状腺素、甲状旁腺素和促甲状腺激素含量，并与正常对照组作了比较。结果 患者T₃、T₄ 、FT₃和TSH含量明显低于对照组，重型SARS患者血清T₃含量明显低于普通型。甲状旁腺素水平 2组间无显著性差异。结论 血清甲状腺素和促甲状腺激素含量变化可能是SARS病程中的一个重要表现。     

原发性甲状旁腺功能亢进症19例分析

目的：探讨原发性甲状旁腺功能亢进症的诊断及外科治疗经验。方法：回顾分析2003年4月—2008年5月行手术治疗的19例原发性甲状旁腺功能亢进症（PHPT）患者的临床资料。结果：全组19例PHPT均经手术和病理证实。女性明显多于男性,临床表现多样化,病程迁延。17例术前血钙及甲状旁腺激素不同程度增高。影像学检查的阳性率：B超为73.33%,CT为60.00%,MRI为75.00%,99mTc-MIBI为100.00%。19例患者均经颈前弧形切口行甲状旁腺切除术,16例为甲状旁腺腺瘤;2例为甲状旁腺腺瘤伴灶性癌变;1例为甲状旁腺增生。术后随访10个月至6年,17例无复发,1例因甲状腺肿瘤再次手术,1例失访。结论：B超和99mTc-MIBI检查可作为诊断甲状旁腺疾病的首选定位诊断方法,同时行此两项检查能提高对甲状旁腺组织定性与定位诊断的准确性。手术切除是最佳的治疗方式。对于多个甲状旁腺增生、甲状旁腺癌和同时伴有甲状腺疾病患者,推荐经颈前弧形切口甲状旁腺切除术为首选手术方式。     

甲状旁腺素对新生大鼠心室肌细胞活力的影响

目的 观察大鼠甲状旁腺素1-34(rat parathyroid hormone 1-34,rPTH1-34)对体外培养新生大鼠心室肌细胞活力的影响.方法 原代培养新生大鼠心室肌细胞,以0.1 μmol/LPTH1-34分别孵育0、12、24、48、72 h,噻唑蓝(MTT)比色法测定细胞活力.结果 心肌细胞活力在12 h时最大(P<0.01),24 h时开始下降,但仍高于正常水平(P<0.01),48 h时降至正常水平,到72 h降至正常水平以下(P<0.05).结论 0.1 ttmol/L PTH刺激12 h时心肌细胞活力最旺盛.     

PTH、细胞内钙和CaSR在心肌损伤中的“三角关系”

正甲状旁腺激素(parathyroid hormone,PTH)是甲状旁腺细胞分泌的调控机体钙磷代谢的重要激素。近年来,PTH对于心肌的毒性作用开始受到人们关注。钙敏感受体(calcium-sensing receptor,CaSR)是G蛋白偶联家族成员之一,可以感受细胞外钙浓度的细微变化,并通过多种途径调节细胞内钙浓度,进而控制PTH的分泌。CaSR在心肌细胞、     

Relationship between mode of delivery and neonatal calcium homeostasis

Serum levels of calcium (Ca), calcitonin (CT) and parathyroid hormone (PTH) were determined in cord blood of 229 newborns. In 136 newborns the tests were repeated 24h later. The probands were divided into four groups according to mode of delivery: (1) spontaneous; (2) elective caesarean section without labour; (3) elective caesarean section in labour; (4) emergency caesarean section with fetal distress. Newborns in group 2 had significantly lower Ca and CT levels and significantly higher PTH concentrations in cord blood than the other three groups. In all groups Ca and PTH concentrations were negatively correlated. At 24 h, mean Ca levels had decreased and mean CT and PTH concentrations had increased in all four groups. Newborns in group 2 still had lower Ca levels but higher CT and PTH concentrations. At that time there were negative correlations between Ca and CT levels in groups 1 and 2 and between Ca and PTH concentrations in group 1. These data demonstrate that without labour, cord blood Ca and CT levels are lower and PTH concentrations are higher. The low 24h calcium in newborns delivered without labour is explained by the lower Ca levels at birth and a tremendous increase of CT. The PTH secretion in full-term newborns is very substantial and negatively correlated with Ca levels.