特发性甲状旁腺功能减退症免疫治疗初探

目的 探讨特发性甲状旁腺功能减退症(IHP)的病因、临床特点及治疗.方法 回顾性分析天津医科大学总医院内分泌科10年的IHP住院病例,共收集24例,其中6例行肌肉活检,10例(41.67%)合并其他自身免疫相关性疾病.免疫抑制组(6例)应用钙剂、活性维生素D、维生素D3和醋酸泼尼松治疗,传统治疗组(18例)应用钙剂、活性维生素D和维生素D3治疗.在上述两组中选择病史、体重和用药剂量相匹配的病例,比较治疗1周时血钙、磷和尿钙、磷的变化幅度.结果 6例肌肉活检均发现肌纤维肿胀,免疫复合物沿肌细胞膜沉积.两组患者中病史、体重和用药剂量相匹配的10例患者进行比较发现:治疗1周时,免疫抑制组的血钙、尿钙升高幅度明显大于传统治疗组(P＜0.01),血磷和尿磷变化幅度无统计学差异(P＞0.05).结论 IHP的病因可能与自身免疫有关,易合并其他自身免疫相关的疾病;加用糖皮质激素(醋酸泼尼松)治疗有利于血钙、尿钙快速上升.

Preliminary research on the immunosuppressive therapy of idiopathic hypoparathyroidism

Objective To study the pathogenesis,clinical characteristics,and therapy of idiopathic hypoparathyroidism.Methods 24 patients with idiopathic hypoparathyroidism,hospitalized in the general hospital of Tianjin Medical University in the last ten years,were colleeeted retrospectively.Among these patients,6 patients were biopsied,10 patients (41.67%) were associated with other autoimmune related diseases.Calcium,calcitriol,VitD3 and prednisone were administrated in the immunosuppressive group(6 cases),while prednisone were not administrated in the traditional management group(18 cases).In the two groups,the patients,whose history,weight and medicine dose were matched,were choosed.After 1 week,the changes of calcium in serum and urine and the changes of phosphorus in serum and urine were compared.Results Muscle fiber swelling and immune complexes were found around perimysia by pathology and immunohitochemistry.In the two groups,10 cases were matched.After one week administration,the changes of calcium in serum and urine of the immunosuppressive group were more obvious than those of the traditional management group(P