Cuppari L, Carvalho A B, Lobão R R, Martini L A, Cendoroglo M, Ventura R T, Draibe S A
Division of Nephrology, Escola Paulista de Medicina, Federal University of São Paulo, Brazil.
Clin Nephrol. 2001 Jul;56(1):35-43.
Adynamic bone disease (ABD) is frequently associated with low serum parathyroid hormone (PTH) concentrations. Many clinical and therapeutic conditions have been associated with ABD, and recently, a low phosphorus intake accompanied by low serum concentration of phosphorus and PTH has been described.
To evaluate the parathyroid gland response of chronic renal insufficiency patients (CRI) with low serum PTH or ABD to a phosphorus load.
We examined the effects of 0.5 and 1.0 g/d of phosphorus load over a period of 60 days in 18 patients with mild CRI with a bone biopsy showing ABD (n = 7) or with low serum PTH (serum intact PTH < or = 40 ng/l) and serum phosphorus < 4.5 mg/dl (n = 11).
Serum intact PTH increased significantly only after 1 g of phosphorus (58.5 to 83 ng/l) with a median percent increase of 72%. PTH secretion increased more in patients with lower basal PTH levels (81%). Serum phosphorus did not change significantly and urinary phosphorus increased from 487 to 1,062 mg/dl (p < 0.05). Significant decreases in serum ionized calcium (from 1.26 to 1.19 mmol/l) and calcitriol (from 34.5 to 24.9 pg/ml) were observed. Changes in PTH were inversely correlated with changes in serum ionized calcium (r = -0.54, p < 0.05) and the final PTH concentrations were positively correlated with changes in serum phosphorus (r= 0.52, p < 0.05).
The parathyroid glands of chronic renal insufficiency patients with "relative hypoparathyroidism" or ABD responded to a phosphorus load with an increase in serum PTH levels. The decrease in serum ionized calcium and calcitriol as well as minimal changes in serum phosphorus appeared to be involved in this response.
动力缺失性骨病（ABD）常与血清甲状旁腺激素（PTH）浓度降低相关。许多临床和治疗情况都与ABD有关，最近，有人描述了低磷摄入伴有血清磷和PTH浓度降低的情况。
评估血清PTH降低或患有ABD的慢性肾功能不全患者（CRI）的甲状旁腺对磷负荷的反应。
我们对18例轻度CRI患者进行了为期60天的研究，给予其每天0.5克和1.0克的磷负荷，这些患者经骨活检显示患有ABD（n = 7）或血清PTH降低（血清完整PTH≤40 ng/l）且血清磷<4.5 mg/dl（n = 11）。
仅在给予1克磷后血清完整PTH显著升高（从58.5至83 ng/l），中位升高百分比为72%。基础PTH水平较低的患者PTH分泌增加更多（81%）。血清磷无显著变化，尿磷从487增加至1,062 mg/dl（p<0.05）。观察到血清离子钙显著降低（从1.26至1.19 mmol/l）和骨化三醇降低（从34.5至24.9 pg/ml）。PTH的变化与血清离子钙的变化呈负相关（r = -0.54，p<0.05），最终PTH浓度与血清磷的变化呈正相关（r = 0.52，p<0.05）。
患有“相对性甲状旁腺功能减退”或ABD的慢性肾功能不全患者的甲状旁腺对磷负荷的反应是血清PTH水平升高。血清离子钙和骨化三醇的降低以及血清磷的微小变化似乎参与了这一反应。
