Intravenous calcitriol therapy in an early stage prevents parathyroid gland growth.
Intravenous calcitriol therapy in an early stage prevents parathyroid gland growth.
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DOI：
10.1093/ndt/gfn264
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发表时间：
2008-11
期刊：
影响因子：
--
通讯作者：
Iida M
中科院分区：
文献类型：
--
作者：
Taniguchi M;Tokumoto M;Tsuruya K;Hirakata H;Iida M
背景甲状旁腺（PT）细胞表型改变，如钙敏感受体的下调，以及结节性增生中PT细胞数量的增加是难治性继发性甲状旁腺功能亢进的主要原因。在早期阶段预防PT生长非常重要。方法.为了研究骨化三醇治疗预防PT增生的更有效方法，我们将轻度甲状旁腺功能亢进的血液透析患者随机分为每日口服骨化三醇（n = 33）或静脉注射骨化三醇（n = 27），为期12个月。调节骨化三醇以使血清完整PTH水平保持在100和150 pg/ml之间。结果两组显示血清PTH水平相似的降低和血清钙相似的升高。在两组中，血清磷酸盐水平没有显著变化。长期每日口服骨化三醇治疗未能防止最大PT体积和总体积的增加，超声检查评估;然而，静脉内骨化三醇治疗成功地抑制了这种进展。在每日口服组中，骨特异性碱性磷酸酶（BAP）和I型胶原N端肽交联（NTX）均显着降低，这可能是由于甲状旁腺激素（PTH）抑制所致。然而，这些骨代谢标志物在静脉注射组中保持稳定。两组研究期间骨化三醇的总剂量相当。结论.这些数据表明，在继发性甲状旁腺功能亢进的早期阶段，静脉内骨化三醇治疗是必要的，以防止PT生长，并保持良好的骨代谢状态。
Background. Both the phenotypic alterations of parathyroid (PT) cells, e.g. down-regulation of the calcium-sensing receptor, and the increase of the PT cell number in nodular hyperplasia are the main causes of refractory secondary hyperparathyroidism. It is of great importance to prevent PT growth in an early stage. Methods. To examine a more effective method of calcitriol therapy for the prevention of PT hyperplasia, we randomized haemodialysis patients with mild hyperparathyroidism to receive either daily orally administered calcitriol (n = 33) or intravenous calcitriol (n = 27) over a 12-month study period. Calcitriol was modulated so as to keep the serum intact PTH level between 100 and 150 pg/ml. Results. Both groups showed similar reductions of the serum PTH level and similar increases in serum calcium. In both groups, there were no significant changes in the serum phosphate level. Long-term daily oral calcitriol therapy failed to prevent the increase of both maximum PT volume and total volume, as assessed by ultrasonography; however, intravenous calcitriol therapy successfully suppressed this progression. In the daily, oral group, both the bone-specific alkaline phosphatase (BAP) and the N-telopeptide cross-linked of type I collagen (NTX) significantly decreased, which was probably due to the PTH suppression. However, these bone metabolism markers remained stable in the intravenous group. The total dosage of calcitriol during the study was comparable in both groups. Conclusions. These data indicate that intravenous calcitriol therapy in an early stage of secondary hyperparathyroidism is necessary to prevent PT growth and to keep a good condition of bone metabolism.
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影响因子：
19.6
作者：
Indridason, OS;Quarles, LD
通讯作者：
Quarles, LD
影响因子：
19.6
作者：
REICHEL, H;SZABO, A;RITZ, E
通讯作者：
RITZ, E
影响因子：
19.6
作者：
Nakanishi, S;Kazama, JJ;Fukagawa, M
通讯作者：
Fukagawa, M
影响因子：
2.5
作者：
FUKAGAWA, M;KITAOKA, M;KUROKAWA, K
通讯作者：
KUROKAWA, K
影响因子：
15.9
作者：
FUKUDA, N;TANAKA, H;SEINO, Y
通讯作者：
SEINO, Y