Drinka Paul J, Krause Peggy F, Nest Lori J, Goodman Brian M
Wisconsin Veterans Home, King, WI 54946-0620, USA.
J Am Med Dir Assoc. 2007 Jun;8(5):328-31. doi: 10.1016/j.jamda.2007.01.099. Epub 2007 May 7.
Elevated parathyroid hormone (PTH) levels contribute to age-related bone loss. Practitioners should be aware of iatrogenic and/or correctable determinants of PTH elevation.
We performed a cross-sectional study including 302 of 609 eligible residents at a state veterans home. Multiple regression analysis was used to determine the effect of 25-OH-D level, glomerular filtration rate (GFR), calcium supplements, diuretics, and mobility status on PTH levels. The dose of calcium carbonate and diuretics was determined as milligram per kilogram of body weight.
The multiple regression process identified GFR, 25-OH-D level, as well as the dose of furosemide and calcium per kilogram of body weight as significant contributors to PTH. In a 70-kg resident, a daily dose of 40 mg of furosemide was associated with an increase of 22.8 pg/mL in PTH, while 500 mg of elemental calcium carbonate (in the absence of a proton pump inhibitor) was associated with a decrease of 8.7 pg/mL in PTH. An increase of 10 ng/mL in 25-OH-D was associated with a decrease of 5.7 pg/mL in PTH.
Clinicians should be aware of the adverse effects of loop diuretics on urinary calcium excretion and PTH levels. Residents who ingest furosemide should be targeted to receive recommended doses of vitamin D and calcium.
甲状旁腺激素（PTH）水平升高会导致与年龄相关的骨质流失。从业者应了解PTH升高的医源性和/或可纠正的决定因素。
我们进行了一项横断面研究，纳入了一家州立退伍军人之家609名符合条件的居民中的302名。采用多元回归分析来确定25-羟维生素D水平、肾小球滤过率（GFR）、钙补充剂、利尿剂和活动状态对PTH水平的影响。碳酸钙和利尿剂的剂量以每千克体重毫克数来确定。
多元回归分析确定GFR、25-羟维生素D水平以及每千克体重的速尿和钙剂量是PTH的重要影响因素。对于一名70千克的居民，每日40毫克速尿剂量与PTH升高22.8皮克/毫升相关，而500毫克元素碳酸钙（在无质子泵抑制剂的情况下）与PTH降低8.7皮克/毫升相关。25-羟维生素D增加10纳克/毫升与PTH降低5.7皮克/毫升相关。
临床医生应意识到袢利尿剂对尿钙排泄和PTH水平的不良影响。服用速尿的居民应针对性地接受推荐剂量的维生素D和钙。
