Reduction of functioning parathyroid cell mass by ethanol injection in chronic dialysis patients.
Reduction of functioning parathyroid cell mass by ethanol injection in chronic dialysis patients.
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慢性透析患者注射乙醇可减少功能性甲状旁腺细胞量。
DOI：
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发表时间：
1994
影响因子：
19.6
通讯作者：
Kiyoshi Kurokawa
中科院分区：
文献类型：
--
作者：
M. Kitaoka;M. Fukagawa;E. Ogata;Kiyoshi Kurokawa
最近的数据表明，较大的甲状旁腺比较小的腺体对骨化三醇治疗更有抵抗力，这是由于骨化三醇受体数量减少更严重。为了控制慢性透析患者对骨化三醇脉冲治疗抵抗的严重继发性甲状旁腺功能亢进，我们在超声引导下使用专门改良的针头向最大的甲状旁腺中引入可重复和定量的乙醇注射。通过彩色多普勒超声检查证实每次注射的有效性和甲状旁腺功能亢进的复发，并可在最佳部位进行额外的乙醇注射。当乙醇注射到最大的腺体不足以控制PTH分泌过多时，我们将乙醇注射到下一个最大的腺体。我们对9名透析患者的16个甲状旁腺进行了32次注射。在7名患者中，最后一次注射后PTH降至低于200 pg/ml，并且通过以下常规口服活性维生素D或骨化三醇脉冲治疗保持控制。另外两名患者，其PTH降低但不低于200 pg/ml，也变得可控与以下骨化三醇脉冲治疗。32次注射中有2次出现复发神经麻痹，但仅为一过性。我们的数据表明，甲状旁腺大小的测量是慢性透析患者继发性甲状旁腺功能亢进的管理策略中的一个重要因素，并且向最大的甲状旁腺注射乙醇可能是一种有效和安全的策略，通过减少对骨化三醇最具抵抗力的甲状旁腺细胞群来恢复对骨化三醇治疗的反应性。
Recent data suggest that the larger parathyroid glands are more resistant to calcitriol therapy than the smaller glands due to more severe reduction of calcitriol receptor number. To control severe secondary hyperparathyroidism resistant to calcitriol pulse therapy in chronic dialysis patients, we introduced repeatable and quantitative ethanol injection(s) into the largest parathyroid gland under ultrasonographic guidance with a specifically modified needle. Efficacy of each injection and the recurrence of hyperparathyroidism were confirmed by color Doppler ultrasonography and could undergo additional ethanol injection(s) into the optimal site. When the ethanol injection(s) into the largest gland was not sufficient to control PTH hypersecretion, we injected ethanol into the next largest gland. We performed 32 injections into 16 parathyroid glands in nine dialysis patients. PTH decreased to less than 200 pg/ml after the final injection in seven patients and they remained controlled either by the following conventional oral active vitamin D or calcitriol pulse therapy. The other two patients, whose PTH decreased but not to less than 200 pg/ml, also became controllable with the following calcitriol pulse therapy. Recurrent nerve palsy was encountered in 2 out of 32 injections, but only transiently. Our data suggest that the measurement of the size of parathyroid glands is an important factor in the management strategy of secondary hyperparathyroidism in chronic dialysis patients, and that ethanol injection(s) into the largest parathyroid gland(s) could be an effective and safe strategy to restore the responsiveness to calcitriol therapy, by reducing the functioning parathyroid cell mass most resistant to calcitriol.
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DOI：
10.1056/nejm198706183162504
发表时间：
1987-06
期刊：
The New England journal of medicine
影响因子：
--
作者：
A. Korkor
通讯作者：
A. Korkor
尿毒症甲状旁腺功能亢进症的进展涉及 11 号染色体上的等位基因丢失。
DOI：
10.1210/jcem.76.1.8421078
发表时间：
1993
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
--
作者：
Falchetti,A;Bale,AE;Amorosi,A;Bordi,C;Cicchi,P;Bandini,S;Marx,SJ;Brandi,ML
通讯作者：
Brandi,ML
DOI：
10.1210/jcem.75.1.1619003
发表时间：
1992-07
期刊：
The Journal of clinical endocrinology and metabolism
影响因子：
--
作者：
L. Quarles;Bruce Lobaugh;G. Murphy
通讯作者：
L. Quarles;Bruce Lobaugh;G. Murphy
影响因子：
15.9
作者：
SLATOPOLSKY, E;WEERTS, C;MARTIN, KJ
通讯作者：
MARTIN, KJ