New assays for parathyroid hormone (PTH) and the relevance of PTH fragments in renal failure.
New assays for parathyroid hormone (PTH) and the relevance of PTH fragments in renal failure.
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甲状旁腺激素 (PTH) 的新检测方法以及 PTH 片段与肾衰竭的相关性。
DOI：
10.1046/j.1523-1755.64.s87.18.x
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发表时间：
2003
期刊：
影响因子：
--
通讯作者：
Goodman,WilliamG
中科院分区：
文献类型：
--
作者：
Goodman,WilliamG
甲状旁腺激素（PTH）和PTH片段在肾功能衰竭中的相关性的新测定方法BackgroundImmunometric测定甲状旁腺激素（PTH）被广泛用于评估用透析治疗的终末期肾病（ESRD）患者的骨和矿物质代谢。结果通常对应于骨活检记录的骨组织学，并且它们在监测疾病进展中是有用的。然而，最近的研究表明，较旧的第一代免疫测定PTH检测不仅检测全长PTH（1-84），而且还检测其他氨基末端截短的PTH片段（ntPTH），这些片段可能对骨细胞代谢具有抑制作用和/或有助于发展成粘附性肾性骨营养不良。相比之下，新的第二代免疫测定PTH检测仅检测PTH（1-84）。血浆甲状旁腺激素测定使用第二代免疫测定甲状旁腺激素检测和效用的估计血浆中的NTPTH浓度与ESRD患者的诊断价值已被评估，只有最近.MethodsResults进行了审查，从三个已发表的研究，检查骨组织学和血浆甲状旁腺激素水平之间的关系，测量的第一和第二代免疫测定甲状旁腺激素检测ESRD患者。在所有这三项研究中，ntPTH的浓度估计从数值之间的差异与每个分析和PTH（1-84）/ntPTH的比率获得的结果进行了calculated.ResultsIn一份报告中，所有的患者与adheric肾性骨营养不良的PTH（1-84）/ntPTH比值<1.0，虽然一些患者高周转骨骼病变也有值<1.0。发现PTH（1-84）/ntPTH比值的估计值比通过任一测定法测量的PTH值更能预测粘连骨。相反，另外两项研究未能证实这些观察结果。其中一项使用了与原始报告中相同的第二代免疫测定PTH试验，而另一项使用了对PTH（1-84）具有相似特异性的不同试验。第一代和第二代检测获得的血浆甲状旁腺素水平高度相关，在这两个独立的reports.ConclusionPlasma PTH水平，确定第一代和第二代免疫测定，是高度相关的，并有类似的诊断价值的非侵入性评估肾性骨营养不良。关于ntPTH估计值和PTH（1-84）/ntPTH比值在肾性骨营养不良诊断评估中有用的论点尚未得到证实。
New assays for parathyroid hormone (PTH) and the relevance of PTH fragments in renal failure.BackgroundImmunometric assays for parathyroid hormone (PTH) are used extensively to assess bone and mineral metabolism in patients with end-stage renal disease (ESRD) who are treated with dialysis. Results generally correspond to bone histology as documented by bone biopsy, and they are useful in monitoring disease progression. Recent work has shown, however, that older, first-generation immunometric PTH assays detect not only full-length PTH(1-84), but also other amino-terminally-truncated PTH fragments (ntPTH) that may have inhibitory effects on bone cell metabolism and/or contribute to the development of adynamic renal osteodystrophy. New second-generation immunometric PTH assays, by contrast, detect PTH(1-84) exclusively. The diagnostic value of plasma PTH determinations using second-generation immunometric PTH assays and the utility of estimates of the concentration of ntPTH in plasma in patients with ESRD has been assessed only recently.MethodsResults were reviewed from three published studies that examined the relationship between bone histology and plasma PTH levels as measured both by first- and by second-generation immunometric PTH assays in patients with ESRD. In all three studies, the concentration of ntPTH was estimated from the numerical difference between the results obtained with each assay and a ratio of PTH(1-84)/ntPTH was calculated.ResultsIn one report, all patients with adynamic renal osteodystrophy had PTH(1-84)/ntPTH ratio values <1.0, although some patients with high-turnover skeletal lesions also had values <1.0. Estimates of the ratio of PTH(1-84)/ntPTH were found to be a better predictor of adynamic bone than PTH values measured by either assay. By contrast, two other studies failed to confirm these observations. One made use of the same second-generation immunometric PTH assay employed in the original report, whereas the other used a different assay with similar specificity for PTH(1-84). Plasma PTH levels obtained by first- and second-generation assays were highly correlated in these two independent reports.ConclusionPlasma PTH levels, as determined by first-generation and second-generation immunometric assays, are highly correlated and have similar diagnostic value for the non-invasive assessment of renal osteodystrophy. The contention that ntPTH estimates and values for the PTH(1-84)/ntPTH ratio are useful in the diagnostic assessment of renal osteodystrophy has yet to be confirmed.
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作者：
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DOI：
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