Development of low‐turnover bone diseases after parathyroidectomy and autotransplantation
Development of low‐turnover bone diseases after parathyroidectomy and autotransplantation
复制标题
甲状旁腺切除术和自体移植后低周转骨病的发生
DOI：
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发表时间：
2001
影响因子：
2.6
通讯作者：
O. Otsubo
中科院分区：
文献类型：
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作者：
A. Yajima;Y. Ogawa;A. Ikehara;T. Tominaga;T. Inou;O. Otsubo
甲状旁腺切除术和即刻自体移植（PTX‐AT）已被证明可以减少骨痛并增加骨密度。然而，如果血清全段甲状旁腺激素（i-PTH）水平长时间低于正常水平，则预计会发生Adjuvic骨病（ABD）。因此，我们研究了PTX-AT后1年血清i-PTH水平升高不超过70 pg/mL的患者的骨组织学。对4例慢性血液透析患者进行了调查。术后1年测量血清完整骨钙素（i-OC）水平，并进行松质骨组织形态计量学检查。在PTX-AT后12周内给予盐酸四环素。血清i-PTH水平为20.5 ± 15.0 pg/mL，i-OC水平为19.5 ± 0.9 ng/mL。组织形态计量学分析显示，破骨细胞表面2例为0.1%，破骨细胞表面2例为0%，侵蚀表面7.7 ± 6.1%，纤维体积和成骨细胞表面均为0%。类骨质体积、类骨质表面和类骨质厚度在病例1-3中较低，但在病例4中较高。在病例1和3中，所有四环素标记均与矿化前沿接触，但在病例2和4中，有些四环素标记未与矿化前沿接触。血清i-PTH和i-OC水平表明这4例病例发生了ABD。组织形态计量学分析显示，病例1发生ABD，而病例2和4发生ABD或低转换骨软化，病例3在PTX-AT后观察到低转换骨软化。总之，i-PTH不应维持在较低水平，以避免低转换骨疾病。
Abstract Parathyroidectomy and immediate autotransplantation (PTX‐AT) has been shown to decrease bone pain and increase bone mineral density. However, adynamic bone disease (ABD) has been predicted to develop if the serum intact parathyroid hormone (i‐PTH) level remains lower than normal for a long period of time. Therefore, we investigated the bone histology of patients whose serum i‐PTH levels did not increase over 70 pg/mL for 1 year after PTX‐AT. Four chronic hemodialysis patients were investigated. The serum intact osteocalcin (i‐OC) level was measured and histomorphometry for cancellous bone was performed 1 year after the operation. Tetracycline hydrochloride was administered in the 12 weeks after PTX‐AT. The serum i‐PTH levels were 20.5 ± 15.0 pg/mL and i‐OC levels were 19.5 ± 0.9 ng/mL. Histomorphometric analyses showed the osteoclast surface to be 0.1% in two cases and 0% in the other two cases, the eroded surface was 7.7 ± 6.1%, and the fibrosis volume and osteoblast surface were 0% in all four cases. Osteoid volume, osteoid surface and osteoid thickness were lower in cases 1–3, but higher in case 4. All tetracycline labelings were in contact with the mineralization front in cases 1 and 3, but some were not in cases 2 and 4. Serum i‐PTH and i‐OC levels indicated that ABD developed in these four cases. Histomorphometric analyses revealed that ABD developed in case 1, while either ABD or low‐turnover osteomalacia developed in cases 2 and 4, and low‐turnover osteomalacia was observed in case 3 after PTX‐AT. In conclusion, i‐PTH should not be maintained at lower levels to avoid low‐turnover bone diseases.