Popovtzer M M, Subryan V L, Alfrey A C, Reeve E B, Schrier R W
J Clin Invest. 1975 Jun;55(6):1295-302. doi: 10.1172/JCI108049.
The acute effects of chlorothiazide (CTZ) on total (TSCA) and ionized (SCA-plus 2) serum calcium concentrations were studied in three groups of people: (a) eight subjects with normal parathyroid function; (b) six patients with hypoparathyroidism; and (c) two patients with hyperparathyroidism. Most subjects were studied on four occasions; at least 3 days intervened between studies on an individual subject. During each experiment the subject received an i.v. influsion of 5% dextrose in water at 1 ml/min from 8 a.m. to 4 p.m. Additions to the infusions were (a) none; (b) CTZ to deliver 3.33 mg/kg/h; (c) parathyroid extract to deliver 1 U/kg/h; or (d) both CTZ and parathyroid extract at the rates previously indicated. CTZ, when used, was added to the infusion at 10 a.m., parathyroid extract at 8 a.m. When CTZ was infused, the diuretic-induced losses of Na and water were replaced by i.v. infusion. In normal subjects 2 h after the start of CTZ infusion, there was a transient increase in SCA-plus 2 which coincided in time of day with a transient decrease in SCA-plus 2 in control experiments. At that time of day SCA-plus 2 was 4.18 plus or minus 0.12 mg/100 ml in control experiments and 4.56 plus or minus 0.08 in experiments with CTZ, P smaller than 0.025. The corresponding values for (TSCA) were 9.32 plus or minus 0.15 and 9.80 plus or minus 0.30, P smaller than 0.01. Such differences were not observed in the group with hypoparathyroidism. In the two patients with hyperparathyroidism, CTZ produced sustained increases in TSCA and SCA-plus 2. In normal subjects and those with hypoparathyroidism, CTZ plus parathyroid extract infusion resulted in sustained increases in both SCA-plus 2 and TSCA throughout the periods of observation when compared to experiments in which only parathyroid extract was infused, P smaller than 0.01 in all instances. The results suggest that the acute hypercalcemic action of CTZ requires the presence of circulating parathyroid hormone.
在三组人群中研究了氯噻嗪（CTZ）对血清总钙（TSCA）和离子钙（SCA-plus 2）浓度的急性影响：（a）八名甲状旁腺功能正常的受试者；（b）六名甲状旁腺功能减退患者；（c）两名甲状旁腺功能亢进患者。大多数受试者进行了四次研究；对单个受试者的研究之间至少间隔3天。在每次实验期间，受试者从上午8点到下午4点以1毫升/分钟的速度静脉输注5%葡萄糖水溶液。输注中添加的物质为：（a）无；（b）CTZ，给药速度为3.33毫克/千克/小时；（c）甲状旁腺提取物，给药速度为1单位/千克/小时；或（d）CTZ和甲状旁腺提取物，给药速度如前所述。使用CTZ时，于上午10点添加到输注液中，甲状旁腺提取物于上午8点添加。输注CTZ时，利尿剂引起的钠和水的丢失通过静脉输注进行补充。在正常受试者中，CTZ输注开始2小时后，SCA-plus 2出现短暂升高，其时间与对照实验中SCA-plus 2的短暂降低时间一致。在该时间段，对照实验中SCA-plus 2为4.18±0.12毫克/100毫升，CTZ实验中为4.56±0.08毫克/100毫升，P<0.0２５。（TSCA）的相应值分别为9.32±0.15和9.80±0.30，P<0.01。在甲状旁腺功能减退组中未观察到此类差异。在两名甲状旁腺功能亢进患者中，CTZ使TSCA和SCA-plus 2持续升高。在正常受试者和甲状旁腺功能减退患者中，与仅输注甲状旁腺提取物的实验相比，输注CTZ加甲状旁腺提取物在整个观察期间使SCA-plus 2和TSCA均持续升高，在所有情况下P<0.01。结果表明，CTZ的急性高钙血症作用需要循环中的甲状旁腺激素存在。
