CALCIUM HOMEOSTASIS IN IMMOBILIZATION - AN EXAMPLE OF RESORPTIVE HYPERCALCIURIA
CALCIUM HOMEOSTASIS IN IMMOBILIZATION - AN EXAMPLE OF RESORPTIVE HYPERCALCIURIA
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DOI：
10.1056/nejm198205133061903
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发表时间：
1982-01-01
影响因子：
158.5
通讯作者：
BROADUS, AE
中科院分区：
文献类型：
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作者：
STEWART, AF;ADLER, M;BROADUS, AE
长期固定可导致高钙血症、高钙尿症和骨质疏松症。虽然骨吸收是该综合征的核心，但吸收的机制尚不确定。特别是，全身性钙调节激素的作用仍不清楚。测定14例固定化受试者空腹钙排泄、限制钙摄入时24小时尿钙排泄、肾磷阈值、血浆1,25-二羟基维生素D、肾源性cAMP和免疫反应性甲状旁腺激素。平均血清钙水平正常，但空腹和24小时钙排泄量明显升高（肾小球滤液为0.28 mg/dl， 24小时为314 mg/dl）。血清P平均水平（4.8 mg/dl）和肾P阈值（4.3 mg/dl）升高。血浆平均1,25-二羟基维生素D显著降低（9.9 pg/ml），肾源性cAMP（肾小球滤液0.64 nmol/dl）和免疫反应性甲状旁腺激素也显著降低。甲状旁腺-1,25-二羟基维生素D轴在固定化诱导的高钙尿症患者中被抑制，正如吸入性高钙尿症模型所预测的那样。
Prolonged immobilization may result in hypercalcemia, hypercalciuria, and osteoporosis. Although bone resorption is central to this syndrome, the mechanism of resorption is uncertain. In particular, the role of systemic Ca-regulating hormones remains unclear. In 14 immobilized subjects fasting Ca excretion, 24-h urinary Ca excretion during restricted Ca intake, the renal P threshold, plasma 1,25-dihydroxyvitamin D, nephrogenous cAMP, and immunoreactive parathyroid hormone were measured. Mean serum Ca levels were normal, but fasting and 24-h Ca excretion were markedly elevated (0.28 mg/dl of glomerular filtrate and 314 mg/24 h, respectively). The mean levels of serum P (4.8 mg/dl) and the renal P threshold (4.3 mg/dl) were elevated. Mean plasma 1,25-dihydroxyvitamin D was strikingly reduced (9.9 pg/ml), as were nephrogenous cAMP (0.64 nmol/dl of glomerular filtrate) and immunoreactive parathyroid hormone in both assays. The parathyroid-1,25-dihydroxyvitamin D axis is suppressed in patients with immobilization-induced hypercalciuria, as would be predicted by a model of resorptive hypercalciuria.