肾小球滤过率对采用全段甲状旁腺激素（PTH）检测法所检测的非（1-84）甲状旁腺激素（PTH）的影响。

Influence of glomerular filtration rate on non-(1-84) parathyroid hormone (PTH) detected by intact PTH assays.

作者信息

Brossard J H, Lepage R, Cardinal H, Roy L, Rousseau L, Dorais C, D'Amour P

机构信息

Centre de Recherche et, Hôpital Saint-Luc, Montreal, Quebec H2X 1P1, Canada.

出版信息

Clin Chem. 2000 May;46(5):697-703.

PMID:10794753

Abstract

BACKGROUND

Commercial intact parathyroid hormone (I-PTH) assays detect molecular form(s) of human PTH, non-(1-84) PTH, different from the 84-amino acid native molecule. These molecular form(s) accumulate in hemodialyzed patients. We investigated the importance of non-(1-84) PTH in the interpretation of the increased I-PTH in progressive renal failure.

METHODS

Five groups were studied: 26 healthy individuals, 12 hemodialyzed patients, and 31 patients with progressive renal failure subdivided according to their glomerular filtration rate (GFR) into 11 with a GFR between 60 and 100 mL. min(-1). 1.73 m(-2), 12 with a GFR between 30 and 60 mL. min(-1). 1.73 m(-2), and 8 with a GFR between 5 and 30 mL. min(-1). 1.73 m(-2). We evaluated indicators of calcium and phosphorus metabolism and creatinine clearance (CrCl) in the progressive renal failure groups, and the HPLC profile of I-PTH and C-terminal PTH in all groups.

RESULTS

Only patients with a GFR <30 mL. min(-1). 1.73 m(-2) and hemodialyzed patients had decreased Ca(2+) and 1,25-dihydroxyvitamin D, and increased phosphate. In patients with progressive renal failure, I-PTH was related to Ca(2+) (r = -0.66; P <0.0001), CrCl (r = -0.61; P <0.001), 1,25-dihydroxyvitamin D (r = -0.40; P <0.05), and 25-hydroxyvitamin D (r = -0.49; P <0.01) by simple linear regression. The importance of non-(1-84) PTH in the composition of I-PTH increased with each GFR decrease, being 21% in healthy individuals, 32% in progressive renal failure patients with a GFR <30 mL. min(-1). 1.73 m(-2), and 50% in hemodialyzed patients, with PTH(1-84) making up the difference.

CONCLUSIONS

As I-PTH increases progressively with GFR decrease, part of the increase is associated with the accumulation of non-(1-84) PTH, particularly when the GFR is <30 mL. min(-1). 1.73 m(-2). Concentrations of I-PTH 1.6-fold higher than in healthy individuals are necessary in hemodialyzed patients to achieve PTH(1-84) concentrations similar to those in the absence of renal failure.

摘要

背景

商业完整甲状旁腺激素（I-PTH）检测法可检测与人甲状旁腺激素（PTH）分子形式不同的非（1-84）PTH，这些分子形式在血液透析患者体内蓄积。我们研究了非（1-84）PTH在解读进行性肾衰竭患者I-PTH升高方面的重要性。

方法

研究分为五组：26名健康个体、12名血液透析患者以及31名进行性肾衰竭患者，后者根据肾小球滤过率（GFR）进一步分为11名GFR在60至100 mL·min⁻¹·1.73 m⁻²之间的患者、12名GFR在30至60 mL·min⁻¹·1.73 m⁻²之间的患者以及8名GFR在5至30 mL·min⁻¹·1.73 m⁻²之间的患者。我们评估了进行性肾衰竭组的钙磷代谢指标和肌酐清除率（CrCl），以及所有组的I-PTH和C端PTH的高效液相色谱图谱。

结果

只有GFR<30 mL·min⁻¹·1.73 m⁻²的患者和血液透析患者的Ca²⁺和1,25 - 二羟维生素D降低，磷酸盐升高。在进行性肾衰竭患者中，通过简单线性回归分析，I-PTH与Ca²⁺（r = -0.66；P<0.0001）、CrCl（r = -0.61；P<0.001）、1,25 - 二羟维生素D（r = -0.40；P<0.05）以及25 - 羟维生素D（r = -0.49；P<0.01）相关。随着GFR每降低一级，非（1-84）PTH在I-PTH组成中的重要性增加，在健康个体中为21%，在GFR<30 mL·min⁻¹·1.73 m⁻²的进行性肾衰竭患者中为32%，在血液透析患者中为50%，其余部分由PTH（1-84）构成。