Llach F, Nikakhtar B
Department of Medicine, University of California, Los Angeles.
Miner Electrolyte Metab. 1991;17(4):250-5.
Secondary hyperparathyroidism is commonly observed in dialysic patients. Recent observations demonstrate a direct inhibitory effect of calcitriol on parathyroid hormone (PTH) synthesis and secretion. These observations may have important clinical and therapeutical implications. Thus, several studies have shown that intravenous calcitriol, in dialysis patients with severe secondary hyperparathyroidism, has a direct inhibitory effect on PTH levels. Furthermore, the sigmoidal PTH-calcium relationship is shifted toward a more normal range after intravenous calcitriol. In addition, the use of calcitriol early during the course of renal failure prior to dialysis has demonstrated therapeutic benefits. Thus, both early therapy with oral calcitriol and later during maintenance dialysis, the addition of the intravenous form may provide various therapeutical alternatives which make surgical parathyroidectomy rarely necessary. Furthermore, the course of patients undergoing surgical parathyroidectomy is not benign.
继发性甲状旁腺功能亢进在透析患者中很常见。最近的观察表明，骨化三醇对甲状旁腺激素（PTH）的合成和分泌有直接抑制作用。这些观察结果可能具有重要的临床和治疗意义。因此，多项研究表明，对于患有严重继发性甲状旁腺功能亢进的透析患者，静脉注射骨化三醇对PTH水平有直接抑制作用。此外，静脉注射骨化三醇后，S形的PTH-钙关系会向更正常的范围转变。此外，在肾衰竭病程早期、透析前使用骨化三醇已显示出治疗益处。因此，无论是早期口服骨化三醇治疗，还是在维持性透析后期添加静脉注射形式，都可能提供多种治疗选择，从而使甲状旁腺切除术很少有必要进行。此外，接受甲状旁腺切除术的患者病程并不乐观。
