Causes of secondary hyperparathyroidism in a healthy population: the Tromso study
Causes of secondary hyperparathyroidism in a healthy population: the Tromso study
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DOI：
10.1007/s00774-005-0647-y
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发表时间：
2006-01-01
影响因子：
3.3
通讯作者：
Figenschau, Y
中科院分区：
文献类型：
--
作者：
Saleh, F;Jorde, R;Figenschau, Y
继发性甲状旁腺功能亢进（SHPT）是机体缺钙时的一种代偿机制。SHPT可能是有害的，并且与血压升高有关。引起SHPT的原因可能是钙摄入量低、肠道钙吸收减少或排泄增加。然而，这些因素对SHPT发展的相对重要性尚不清楚。在第5次特罗姆瑟研究中，对7954名受试者进行了血清甲状旁腺激素和钙的测定。随访96例SHPT患者（定义为血清PTH高于6.4 pmol/l，血清钙低于2.40 mmol/l）和106例对照者，采用进食频率问卷、钙吸收试验、24 h尿钙排泄量测定和血清维生素D水平。统计分析显示了几个相互作用，需要进行亚组分析。研究发现，SHPT组的钙摄入量明显降低，但仅限于不吸烟的男性；SHPT组钙吸收率无显著性增高；SHPT组血清25-羟基维生素D水平显著降低，但仅在非吸烟者中显著降低；SHPT组24小时尿钙排泄量明显降低，但仅在不服用降压药的组中。SHPT最常见的原因似乎是低钙摄入（18%）和低血清25-羟基维生素D水平（18%）。然而，在大多数SHPT受试者中，所有测试都在正常范围内，因此原因可能是几个因素的组合。
Secondary hyperparathyroidism (SHPT) develops as a compensatory mechanism when the body is in calcium deficit. SHPT may be harmful and has been associated with elevated blood pressure. The cause of SHPT could be low calcium intake, reduced intestinal calcium absorption, or increased excretion. However, the relative importance of these factors for the development of SHPT is not known. During the 5th Tromso study, serum PTH and calcium were measured in 7954 subjects. Then 96 subjects with SHPT (defined as serum PTH above 6.4 pmol/l together with serum calcium below 2.40 mmol/l) and 106 control subjects were examined at follow-up with a food frequency questionnaire, calcium absorption test, measurement of 24-h urinary calcium excretion, and serum vitamin D status. The statistical analyses showed several interactions necessitating subgroup analysis. It was found that the calcium intake was significantly lower in the SHPT group, but only in nonsmoking males; the calcium absorption was nonsignificantly higher in the SHPT group; the serum 25-hydroxyvitamin D levels were significantly lower in the SHPT group but only in nonsmokers; and the 24-h urinary calcium excretion was significantly lower in the SHPT group but only in those not on blood pressure medication. The most frequent cause of SHPT appeared to be low calcium intake (18%) and a low serum 25-hydroxyvitamin D level (18%). However, in most subjects with SHPT all tests were within the normal range, and the cause is therefore probably a combination of several factors.