Direct injections of calcitriol into enlarged parathyroid glands in chronic dialysis patients with severe parathyroid hyperfunction
Direct injections of calcitriol into enlarged parathyroid glands in chronic dialysis patients with severe parathyroid hyperfunction
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骨化三醇直接注射到患有严重甲状旁腺功能亢进的慢性透析患者肿大的甲状旁腺中
DOI：
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发表时间：
1995
期刊：
影响因子：
--
通讯作者：
K. Kurokawa
中科院分区：
文献类型：
--
作者：
M. Kitaoka;M. Fukagawa;N. Fukuda;H. Yi;E. Ogata;K. Kurokawa
总结：慢性透析患者的严重继发性甲状旁腺功能亢进症最近已通过超生理浓度的骨化三醇脉冲治疗来治疗。然而，有许多患者对这种疗法有抵抗力，他们通常有较大的甲状旁腺。为了克服这种阻力，在超声引导下将骨化三醇直接注射到增大的腺体中。我们向7名患者的腺体中注射了计算腺体体积的70-90%的骨化三醇溶液（1 μg/mL），每周3次，持续2周。在直接注射骨化三醇2周后，甲状旁腺激素（PTH）水平显著降低。经过4周的骨化三醇脉冲治疗，PTH水平仍然受到抑制，血清碱性磷酸酶活性和甲状旁腺体积也下降。在长期随访期间，5名患者通过骨化三醇脉冲治疗保持良好控制，而2名患者需要注射乙醇来控制甲状旁腺功能亢进。虽然我们不能完全排除媒介物的毒性作用，但将骨化三醇直接注射到甲状旁腺中可能是慢性透析患者的另一种治疗选择。我们的数据进一步支持甲状旁腺细胞对骨化三醇的抵抗在尿毒症患者甲状旁腺功能亢进的发病机制中的重要作用。
Summary: Severe secondary hyperparathyroidism in chronic dialysis patients has been recently treated by supraphysiological concentration of calcitriol achieved through pulse therapy. However, there are many patients resistant to this therapy, who usually have larger parathyroid gland(s). to overcome this resistance, calcitriol was injected directly into the enlarged glands under ultrasonographic guidance. We injected 70–90% of the calculated gland volume of calcitriol solution (1 μg/mL) into the glands of 7 patients three times per week for 2 weeks. the parathyroid hormone (PTH) levels decreased significantly after 2 weeks of direct injections of calcitriol. Following a further 4 weeks of calcitriol pulse therapy, PTH levels remained suppressed and serum alkaline phosphatase activity and the volume of parathyroid glands also decreased. During the long‐term follow up, five patients remained well controlled with calcitriol pulse therapy, while two patients needed ethanol injections to control hyperparathyroidism. Although we could not completely rule out a toxic effect of the vehicle, direct injection of calcitriol into parathyroid glands may be another treatment option for chronic dialysis patients. Our data further support the important role of resistance of parathyroid cells to calcitriol in the pathogenesis of parathyroid hyper function in uraemic patients.
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DOI：
10.1056/nejm198706183162504
发表时间：
1987-06
期刊：
The New England journal of medicine
影响因子：
--
作者：
A. Korkor
通讯作者：
A. Korkor
影响因子：
4.8
作者：
DUSSO, AS;NEGREA, L;BROWN, AJ
通讯作者：
BROWN, AJ
DOI：
10.1210/jcem.75.1.1619003
发表时间：
1992-07
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
--
作者：
L. Quarles;Bruce Lobaugh;G. Murphy
通讯作者：
L. Quarles;Bruce Lobaugh;G. Murphy
影响因子：
15.9
作者：
SLATOPOLSKY, E;WEERTS, C;MARTIN, KJ
通讯作者：
MARTIN, KJ