Direct inhibitory effect of calcitriol on parathyroid function (sigmoidal curve) in dialysis.
Direct inhibitory effect of calcitriol on parathyroid function (sigmoidal curve) in dialysis.
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骨化三醇对透析中甲状旁腺功能（乙状曲线）的直接抑制作用。
DOI：
10.1038/ki.1989.305
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发表时间：
1989
影响因子：
19.6
通讯作者：
Francisco Llach
中科院分区：
文献类型：
--
作者：
Robert W. Dunlay;Mariano Rodríguez;A. Felsenfeld;Francisco Llach
本文观察了9例慢性血液透析伴继发性甲状旁腺功能亢进患者静脉注射骨化三醇对甲状旁腺功能的影响。透析后静脉注射2微克骨化三醇，每周三次，持续十周。在静脉注射骨化三醇治疗10周前后，通过低钙（1.0 mEq/l）和高钙（4.0 mEq/l）透析诱导低钙和高钙血症评估甲状旁腺功能。为避免骨化三醇给药期间出现高钙血症，透析液钙降至2.5 mEq/l。将透析引起的低钙血症和高钙血症的甲状旁腺激素（PTH）值（pg/ml）与血清离子钙进行对比，并评估甲状旁腺激素与钙之间的s型关系。治疗后PTH基础水平从902 +/- 126 pg/ml降至466 +/- 152 pg/ml (P < 0.01)，血清总钙浓度无明显变化。骨化三醇治疗后，离子钙-甲状旁腺素s型曲线向左下移。骨化三醇后低钙患者的最大PTH反应从骨化三醇前的1661 +/- 485 pg/ml下降到骨化三醇后的1031 +/- 280 pg/ml （P < 0.05）。高钙血症最大抑制时PTH水平由骨化三醇治疗前的281 +/- 76 pg/ml降至骨化三醇治疗后的192 +/- 48 pg/ml （P < 0.05）。s型曲线斜率由-2125 +/- 487变为-1563 +/- 385 （P < 0.05）。骨化三醇治疗后，离子钙的设定点（治疗前为4.60 +/- 0.11 mg/dl，治疗后为4.44 +/- 0.07 mg/dl）没有显著变化。（摘要删节250字）
The effect of intravenous calcitriol on parathyroid function was evaluated in nine chronic hemodialysis patients with secondary hyperparathyroidism. Two micrograms of calcitriol were administered intravenously after dialysis thrice weekly for ten weeks. Parathyroid function was assessed by inducing hypo- and hypercalcemia with low calcium (1.0 mEq/liter) and high calcium (4.0 mEq/liter) dialyses before and after ten weeks of intravenous calcitriol therapy. To avoid hypercalcemia during calcitriol administration, the dialysate calcium was reduced to 2.5 mEq/liter. Parathyroid hormone (PTH) values (pg/ml) from dialysis-induced hypo- and hypercalcemia were plotted against serum ionized calcium, and the sigmoidal relationship between PTH and calcium was evaluated. Basal PTH levels fell from 902 +/- 126 pg/ml to 466 +/- 152 pg/ml (P less than 0.01) after therapy without a significant change in the serum total calcium concentration. The ionized calcium-PTH sigmoidal curve shifted to the left and downward after calcitriol therapy. The maximal PTH response during hypocalcemia decreased after calcitriol from 1661 +/- 485 pg/ml before calcitriol to 1031 +/- 280 pg/ml afterward (P less than 0.05). The PTH level at maximal inhibition due to hypercalcemia decreased from 281 +/- 76 pg/ml before calcitriol to 192 +/- 48 pg/ml afterward (P less than 0.05). The slope of the sigmoidal curve changed from -2125 +/- 487 to -1563 +/- 385 (P less than 0.05). The set point of ionized calcium (4.60 +/- .11 mg/dl before vs. 4.44 +/- .07 mg/dl after) did not change significantly with calcitriol therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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