Pulse oral calcitriol for the treatment of hyperparathyroidism in patients on continuous ambulatory peritoneal dialysis: preliminary observations.
Pulse oral calcitriol for the treatment of hyperparathyroidism in patients on continuous ambulatory peritoneal dialysis: preliminary observations.
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脉冲口服骨化三醇治疗连续不卧床腹膜透析患者的甲状旁腺功能亢进症：初步观察。
DOI：
10.1016/s0272-6386(12)80832-8
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发表时间：
1992
期刊：
影响因子：
--
通讯作者：
Weindel,M
中科院分区：
文献类型：
--
作者：
Martin,KJ;Ballal,HS;Domoto,DT;Blalock,S;Weindel,M
骨化三醇对甲状旁腺激素（PTH）分泌调节的直接作用已在体外和体内显示。在维持性血液透析的肾衰竭患者中，已证明静脉（IV）给予骨化三醇似乎上级连续口服给药。这可能是由于血液中获得的骨化三醇水平较高，从而改善了骨化三醇向包括甲状旁腺在内的外周靶组织的递送。然而，骨化三醇的IV给药对于维持持续非卧床腹膜透析（CAPO）的终末期肾病（ESRD）患者是不切实际的。本研究旨在研究间歇性口服大剂量骨化三醇（“脉冲疗法”）是否可以模拟静脉注射骨化三醇对血液透析患者的作用，并抑制PTH分泌。研究中进行了5例患者已维持在CAPO超过6个月。在测定钙、磷和PTH的基础值后，开始以骨化三醇口服治疗，剂量为5 μ g，每周两次。继续使用碳酸钙作为磷酸盐结合剂。透析液钙浓度为1.75 mmol/L（3.5 mEq/L）。使用这种疗法，PTH水平迅速下降，并且在治疗4至6周后，达到比治疗前值低60%的值。血清钙的平均值无显著变化（治疗前为2.29 ± 0.12 mmol/L [9.6 ± 0.5 mg/dL]，治疗后为2.32 ± 0.08 mmol/L [9.7 ± 0.25 mg/dL]）。平均血清磷也无变化。这些数据表明，在这些短期研究中，口服骨化三醇的间歇性脉冲治疗耐受性良好，并导致PTH分泌的实质性抑制。这种治疗模式可能有利于控制CAPD患者的甲状旁腺功能亢进。
A direct effect of calcitriol on the regulation of the secretion of parathyroid hormone (PTH) has been shown in vitro and in vivo. In patients with renal failure on maintenance hemodialysis, it has been shown that intravenous (IV) administration of calcitriol appears to be superior to continuous oral administration. This may be due to the higher levels of calcitriol obtained in blood with consequent improved delivery of calcitriol to peripheral target tissues including the parathyroid glands. However, IV administration of calcitriol, is not practical for patients with end-stage renal disease (ESRD) who are maintained on continuous ambulatory peritoneal dialysis (CAPO). The present studies were designed to investigate whether intermittent administration of large doses of calcitriol orally (“pulse therapy”) could mimic the effects of IV calcitriol in hemodialysis patients and achieve suppression of PTH secretion. Studies were performed in five patients who had been maintained on CAPO for more than 6 months. After basal determinations of calcium, phosphorus, and PTH, therapy was begun with calcitriol administered orally in a dose of 5 δg given twice per week. Calcium carbonate was continued as a phosphate binder. Dialysate calcium concentration was 1.75 mmol/L (3.5 mEq/L). With this therapy, PTH levels decreased rapidly, and, after 4 to 6 weeks of therapy, reached values 60% lower than pretreatment values. Mean values for serum calcium did not change significantly (2.29 ± 0.12 mmol/L [9.6 ± 0.5 mg/dL] before treatment compared with 2.32 ± 0.08 mmol/L [9.7 ± 0.25 mg/dL] after therapy). Mean serum phosphorus was also unchanged. These data indicate that in these short-term studies, intermittent pulse therapy with calcitriol, administered orally, was well tolerated and resuHed in substantial suppression of PTH secretion. This mode of therapy may be advantageous for the control of hyperparathyroidism in patients on CAPD.