High ratio of 1,25-dihydroxyvitamin D3 to parathyroid hormone in serum of tuberculous patients with end-stage renal disease.
High ratio of 1,25-dihydroxyvitamin D3 to parathyroid hormone in serum of tuberculous patients with end-stage renal disease.
复制标题
患有终末期肾病的结核病患者血清中1,25-二羟基维生素D3与甲状旁腺激素的比例较高。
DOI：
10.5414/cnp62202
复制
发表时间：
2004
影响因子：
1.1
通讯作者：
A. Hishida
中科院分区：
文献类型：
--
作者：
K. Yonemura;T. Ohtake;H. Matsushima;Y. Fujigaki;A. Hishida
目标
结核病的诊断有时很困难，因为诊断程序的特异性很低，特别是在终末期肾病(ESRD)患者中。鉴于结核病中维生素D代谢异常的报道，本研究的目的是确定1，25-二羟基维生素D3(1，25-(OH)2D3)血清浓度是否可作为终末期肾病患者结核病的有用诊断指标。
患者和方法
比较6例ESRD合并活动性肺结核患者(ESRD-TB组)和110例ESRD非结核患者(ESRD组)血清1，25-(OH)2D3、甲状旁腺激素(PTH)和钙的浓度。对ESRD-TB组患者治疗前后的上述指标进行比较。
结果
ESRD-TB组6例患者均出现高钙血症。ESRD-TB组血清1，25-(OH)2D3浓度高于ESRD-TB组，而PTH血清浓度低于ESRD-TB组，提示ESRD-TB组肾外1，25-(OH)2D3生成增加，PTH分泌受抑制。然而，这些参数不能用于区分ESRD-TB组和ESRD组。ESRD-TB组血清1，25-(OH)2D3/PTH比值>0.9，ESRD组<0.9。抗结核治疗将这一比率降低到ESRD组观察到的范围。
结论
活动期ESRD患者血清中1，25-(OH)2D3与甲状旁腺素的比值较高，这是由于肾外1，25-(OH)2D3的产生增加所致。
AIM
Diagnosis of tuberculosis is sometimes difficult because of the low specificity of diagnostic procedures especially in patients on end-stage renal disease (ESRD). As abnormal vitamin D metabolism has been reported in tuberculosis, the aim of the present study was to determine whether serum concentration of 1,25-dihydroxyvitamin D3 (1,25-(OH)2D3) may be a useful diagnostic indicator of tuberculosis in patients with ESRD.
PATIENTS AND METHODS
Serum concentrations of 1,25-(OH)2D3, parathyroid hormone (PTH), and calcium were compared in 6 patients with ESRD and active tuberculosis (ESRD-TB group) and 110 patients with ESRD and no tuberculosis (ESRD group). These parameters were compared before and after treatment for tuberculosis in patients of ESRD-TB group.
RESULTS
Hypercalcemia was observed in all 6 patients in the ESRD-TB group. Both higher serum concentration of 1,25-(OH)2D3 and lower serum concentration of PTH were observed in the ESRD-TB group relative to the ESRD group, suggesting enhanced extrarenal production of 1,25-(OH)2D3 and suppressed secretion of PTH by hypercalcemia in the ESRD-TB group. However, these parameters could not be used to distinguish the ESRD-TB group from the ESRD group. The ratio of 1,25-(OH)2D3 to PTH in serum was above 0.9 in the ESRD-TB group and below 0.9 in the ESRD group. Antituberculous treatment reduced this ratio to the range observed in the ESRD group.
CONCLUSION
High ratio of 1,25-(OH)2D3 to PTH in serum is noted in active tuberculous patients with ESRD because of enhanced extrarenal production of 1,25-(OH)2D3.