Calcium Metabolism in Health and Disease
Calcium Metabolism in Health and Disease
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DOI：
10.2215/cjn.05910809
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发表时间：
2010-01-01
影响因子：
9.8
通讯作者：
Peacock, Munro
中科院分区：
文献类型：
--
作者：
Peacock, Munro
本文就健康受试者和慢性肾脏疾病及矿物性骨病(CKD-MBD)患者的钙平衡和动态平衡及其与膳食钙摄入量和补钙的关系作一简要综述。钙平衡是指体内储存的钙的状态，主要是在骨骼中，这在很大程度上是饮食摄入、肠道吸收、肾脏排泄和骨骼重塑的功能。骨钙平衡可以是正的、中性的，也可以是负的，这取决于许多因素，包括生长、衰老和后天或遗传性疾病。钙稳态是指甲状旁腺激素、1，25-二羟基维生素D和血清离子钙本身对血清离子钙的激素调节，它们共同调节肠道、肾脏和骨骼的钙转运。高钙血症和低钙血症提示严重的钙平衡紊乱，但本身并不反映钙平衡。钙平衡研究已经确定了优化健康受试者骨量所需的饮食和补充钙的需求。然而，在CKD-MBD中也需要类似的研究，它破坏了钙平衡和体内平衡，因为这些数据在健康受试者中可能不能推广到这一患者组。重要的是，越来越多的证据表明，补钙可能会增强CKD-MBD的软组织钙化和心血管疾病。在健康受试者和CKD-MBD患者中，需要进一步的研究来阐明补钙软组织钙化的风险和机制。临床医学杂志5：S23-S30,2010。DOI：10.2215/CJN.05910809
This brief review focuses on calcium balance and homeostasis and their relationship to dietary calcium intake and calcium supplementation in healthy subjects and patients with chronic kidney disease and mineral bone disorders (CKD-MBD). Calcium balance refers to the state of the calcium body stores, primarily in bone, which are largely a function of dietary intake, intestinal absorption, renal excretion, and bone remodeling. Bone calcium balance can be positive, neutral, or negative, depending on a number of factors, including growth, aging, and acquired or inherited disorders. Calcium homeostasis refers to the hormonal regulation of serum ionized calcium by parathyroid hormone, 1,25-dihydroxyvitamin D, and serum ionized calcium itself, which together regulate calcium transport at the gut, kidney, and bone. Hypercalcemia and hypocalcemia indicate serious disruption of calcium homeostasis but do not reflect calcium balance on their own. Calcium balance studies have determined the dietary and supplemental calcium requirements needed to optimize bone mass in healthy subjects. However, similar studies are needed in CKD-MBD, which disrupts both calcium balance and homeostasis, because these data in healthy subjects may not be generalizable to this patient group. Importantly, increasing evidence suggests that calcium supplementation may enhance soft tissue calcification and cardiovascular disease in CKD-MBD. Further research is needed to elucidate the risks and mechanisms of soft tissue calcification with calcium supplementation in both healthy subjects and CKD-MBD patients. Clin J Am Soc Nephrol 5: S23-S30, 2010. doi: 10.2215/CJN.05910809