Intermittent calcitriol therapy in secondary hyperparathyroidism: a comparison between oral and intraperitoneal administration.
Intermittent calcitriol therapy in secondary hyperparathyroidism: a comparison between oral and intraperitoneal administration.
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DOI：
10.1046/j.1523-1755.1998.00045.x
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发表时间：
1998-09
影响因子：
19.6
通讯作者：
I. Salusky;I. Salusky;B. Kuizon;B. Kuizon;Thomas R. Belin;Thomas R. Belin;J. Ramirez;J. Ramirez;B. Gales;B. Gales;G. V. Segre;G. V. Segre;William G. Goodman;William G. Goodman
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文献类型：
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作者：
I. Salusky;I. Salusky;B. Kuizon;B. Kuizon;Thomas R. Belin;Thomas R. Belin;J. Ramirez;J. Ramirez;B. Gales;B. Gales;G. V. Segre;G. V. Segre;William G. Goodman;William G. Goodman
背景每周两次或三次间断口服或静脉注射骨化三醇通常用于治疗继发性甲状旁腺功能亢进（继发性HPT）。进行本研究以比较每周三次腹膜内（i. p.）与口服剂量的骨化三醇在接受腹膜透析（CCPD）的继发性HPT儿童中的比较。方法46例年龄为12.5 ± 4.8岁，接受CCPD治疗22 ± 25个月的患者随机分为口服（p.o.）或腹膜内给予骨化三醇12个月; 17名受试者口服给予骨化三醇12个月。骨化三醇和16名腹膜内给予骨化三醇的受试者完成了研究。在研究开始和结束时进行骨活检，同时每月测定血清和总离子钙、磷、碱性磷酸酶、甲状旁腺激素（PTH）和骨化三醇水平。结果腹膜内给予骨化三醇的受试者血清总钙和离子钙水平较高，P < 0.0001，而口服给予骨化三醇的受试者血清磷水平较高。骨化三醇，P < 0.0001。对于腹膜内注射组，血清PTH水平从治疗前的648+/-125 pg/ml下降到9个月后的最低点169+/-57 pg/ml。相比之下，口服给药受试者的血清PTH水平与基线值670+/-97 pg/ml相比没有变化。多元回归分析显示骨化三醇组P < 0.0001。腹膜内给予骨化三醇治疗的患者血清碱性磷酸酶水平也较低，P < 0.0001，但两组间每周给予三次骨化三醇的平均剂量无差异。两组继发性HPT的骨骼病变均得到改善，33%的患者发生粘连性骨病变。结论骨化三醇的生物利用度和/或磷代谢的差异可能解释了对p.o.和腹膜内骨化三醇。
BACKGROUND Intermittent oral or intravenous doses of calcitriol given two or three times per week are commonly used to treat secondary hyperparathyroidism (secondary HPT). This study was undertaken to compare the biochemical and skeletal responses to thrice weekly intraperitoneal (i.p.) versus oral doses of calcitriol in children with secondary HPT undergoing peritoneal dialysis (CCPD). METHODS Forty-six patients aged 12.5+/-4.8 years on CCPD for 22+/-25 months were randomly assigned to treatment with oral (p.o.) or i.p. calcitriol for 12 months; 17 subjects given p.o. calcitriol and 16 subjects given i.p. calcitriol completed the study. Bone biopsies were performed at the beginning and at the end of the study, while determinations of serum and total ionized calcium, phosphorus, alkaline phosphatase, parathyroid hormone (PTH) and calcitriol levels were done monthly. RESULTS Serum total and ionized calcium levels were higher in subjects treated with i.p. calcitriol, P < 0.0001, whereas serum phosphorus levels were higher in those given p.o. calcitriol, P < 0.0001. For the i.p. group, serum PTH levels decreased from pre-treatment values of 648+/-125 pg/ml to a nadir of 169+/-57 pg/ml after nine months. In contrast, serum PTH levels did not change from baseline values of 670+/-97 pg/ml in subjects given p.o. calcitriol, P < 0.0001 by multiple regression analysis. Serum alkaline phosphatase levels were also lower in patients treated with i.p. calcitriol, P < 0.0001, but there was no difference between groups in the average dose of calcitriol given thrice weekly. The skeletal lesions of secondary HPT improved in both groups, 33% of patients developed adynamic bone lesion. CONCLUSION Differences in the bioavailability of calcitriol and/or in phosphorus metabolism may account for the divergent biochemical response to p.o. and i.p. calcitriol.