PTH 1-84 and PTH "7-84" in the noninvasive diagnosis of renal bone disease
PTH 1-84 and PTH "7-84" in the noninvasive diagnosis of renal bone disease
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DOI：
10.1053/ajkd.2002.34519
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发表时间：
2002-08-01
影响因子：
13.2
通讯作者：
Sardella, D
中科院分区：
文献类型：
--
作者：
Coen, G;Bonucci, E;Sardella, D
背景资料：全段甲状旁腺激素（PTH）测定评价血清1-84 PTH和其他N-末端截短的PTH片段（主要是PTH-7-84）的水平。“实验发现这种PTH分子可能通过与PTH受体复合物结合来干扰PTH 1-84的生物活性。因此，假设高水平的PTH 7-84是对PTH的骨抵抗的原因，已经假设由PTH 7-84水平的相对增加引起的1-84与7-84 PTH比率的降低可能有助于低转换骨营养不良（LTO）的非侵入性诊断。研究方法：本研究在35例接受血液透析治疗的慢性肾功能衰竭患者中进行，这些患者接受骨活检进行组织学、组织形态计量学和组织动力学研究。此外，获得血液样品用于完整PTH、1-84 PTH和总PTH测定。PTH 7-84水平从总PTH测定结果和1-84 PTH测定结果之间的差异获得。结果如下：其中LTO 9例（8例为粘连性骨病，1例为骨软化症），12例为甲状旁腺功能亢进（HP），14例为混合性骨营养不良（MO）。平均而言，1-84 PTH水平约为完整PTH平均值的60%。这两种检测方法严格相关。三个组织学组（分别为LTO、HP和MO）的平均1-84与7-84 PTH比值分别为1.57 +/- 0.85、1.73 +/- 1.31和1.95 +/- 2.1，无显著差异。结论：与先前的预期相反，结果不支持7-84 PTH在肾性骨营养不良的骨抵抗中的作用的假设。1-84与7-84的PTH比值不是LTO的标志物，在非侵入性组织学诊断中没有用处。(C)2002年，美国国家肾脏基金会（National Kidney Foundation，Inc.）
Background: The intact parathyroid hormone (PTH) assay evaluates levels of serum 1-84 PTH and other N-terminally truncated PTH fragments, mainly PTH "7-84." This PTH molecule has been found experimentally to interfere with biological activity of PTH 1-84, perhaps through its binding to the PTH receptor complex. Therefore, assuming that high levels of PTH 7-84 are a cause of bone resistance to PTH, it has been hypothesized that a decreased 1-84 to 7-84 PTH ratio caused by a relative increase in PTH 7-84 level might help in the noninvasive diagnosis of low-turnover osteodystrophy (LTO). Methods: This study was performed in 35 patients with chronic renal failure on hemodialysis therapy who underwent bone biopsy for a histological, histomorphometric, and histodynamic study. In addition, blood samples were obtained for intact PTH, 1-84 PTH, and total PTH assays. PTH 7-84 level was obtained from the difference between total and 1-84 PTH assay results. Results: Nine patients had LTO (8 patients, adynamic bone disease; 1 patient, osteomalacia),12 patients had hyperparathyroidism (HP), and 14 patients had mixed osteodystrophy (MO). On average, 1-84 PTH levels were approximately 60% of mean values for intact PTH. The two assays were strictly correlated. Average 1-84 to 7-84 PTH ratios were 1.57 +/- 0.85, 1.73 +/- 1.31, and 1.95 +/- 2.1 in the three histological groups (LTO, HP, and MO, respectively), with no significant difference. Conclusion: Contrary to previous expectations, results do not favor the hypothesis of a role of 7-84 PTH in bone resistance in renal osteodystrophy. The 1-84 to 7-84 PTH ratio is not a marker of LTO and is of no use in noninvasive histological diagnosis. (C) 2002 by the National Kidney Foundation, Inc.