SERIAL EVALUATION OF PARATHYROID SIZE BY ULTRASONOGRAPHY IS ANOTHER USEFUL MARKER FOR THE LONG-TERM PROGNOSIS OF CALCITRIOL PULSE THERAPY IN CHRONIC DIALYSIS PATIENTS
SERIAL EVALUATION OF PARATHYROID SIZE BY ULTRASONOGRAPHY IS ANOTHER USEFUL MARKER FOR THE LONG-TERM PROGNOSIS OF CALCITRIOL PULSE THERAPY IN CHRONIC DIALYSIS PATIENTS
复制标题
DOI：
10.1159/000188261
复制
发表时间：
1994-10-01
期刊：
影响因子：
2.5
通讯作者：
KUROKAWA, K
中科院分区：
文献类型：
--
作者：
FUKAGAWA, M;KITAOKA, M;KUROKAWA, K
为了明确甲状旁腺大小的变化是否与骨化三醇脉冲治疗的长期预后相关，我们检测了14例慢性透析患者在口服骨化三醇脉冲治疗期间和之后的血清甲状旁腺激素（PTH）水平和甲状旁腺大小的时间过程。在5例未检出腺体的患者中，骨化三醇脉冲治疗后再常规口服活性维生素D治疗，继发性甲状旁腺功能亢进容易控制。在2例可检测到腺体的患者中，所有甲状旁腺的大小以及甲状旁腺激素的高分泌通过骨化三醇脉冲治疗恢复正常，继发性甲状旁腺功能亢进在改用常规口服活性维生素D治疗后至少可以控制12个月。相比之下，在骨化三醇脉冲治疗所有甲状旁腺大小未恢复正常的7例患者中，即使PTH分泌亢进可以暂时控制，改用常规治疗后继发性甲状旁腺功能亢进仍复发。我们的研究结果表明，超声检查甲状旁腺增生的病程是骨化三醇脉冲治疗疗效和预后的重要决定因素。因此，继发性甲状旁腺功能亢进的治疗应考虑甲状旁腺大小的变化以及甲状旁腺分泌过多。
To clarify whether the changes of parathyroid size have any correlations with the long-term prognosis of calcitriol pulse therapy, we examined the time course of serum levels of parathyroid hormone (PTH) and size of parathyroid glands in 14 chronic dialysis patients during and after the oral calcitriol pulse therapy. In 5 patients without any detectable glands, secondary hyperparathyroidism was easily controlled by calcitriol pulse therapy and then by conventional oral active vitamin D therapy. In 2 patients with detectable gland(s) in whom size of all parathyroid glands as well as PTH hypersecretion regressed to normal by calcitriol pulse therapy, secondary hyperparathyroidism could then remain controlled at least for 12 months after switching to conventional oral active vitamin D therapy. In contrast, in 7 patients in whom size of all parathyroid glands did not regress to normal by calcitriol pulse therapy, secondary hyperparathyroidism relapsed after switching to the conventional therapy, even if PTH hypersecretion could be controlled temporarily. Our findings suggest that the time course of parathyroid hyperplasia detected by ultrasonography is an important determinant of the efficacy and the prognosis of calcitriol pulse therapy. Thus, the change of parathyroid gland size as well as PTH hypersecretion should be taken into account for the management of secondary hyperparathyroidism.