Komaba Hirotaka, Goto Shunsuke, Fukagawa Masafumi
Division of Nephrology and Kidney Center, Kobe University School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ko, Kobe 650-0017, Japan.
Bone. 2009 Apr;44(4):666-70. doi: 10.1016/j.bone.2008.12.016. Epub 2008 Dec 30.
Measurement of bioactive parathyroid hormone (PTH) is essential for the optimal management of secondary hyperparathyroidism and its associated bone disorders in chronic kidney disease (CKD) patients. For this purpose, three generations of increasingly specific PTH assays have been developed over the last 4 decades. To date, however, only second-generation PTH assays are most widely used, although these have been shown to cross-react with large PTH fragments having a partially preserved N-structure, mostly PTH(7-84). The newly developed third-generation PTH assays are believed to be the most specific means of measuring PTH(1-84), but their clinical utility remains debatable. More recently, these latter assays have also been shown to react with a new N-form of PTH, which has been identified in patients with severe hyperparathyroidism and parathyroid carcinoma. Progressive research in this area has advanced our understanding considerably regarding the circulating molecular forms of PTH and their pathophysiological roles in bone abnormalities associated with CKD. However, developing an ideal PTH assay continues to be difficult because of key issues such as the reliability of PTH as a surrogate marker for bone turnover, practicality of employing third-generation PTH assays, and unknown biological implications of N-PTH and other PTH fragments. Further research exploring these issues is mandatory to understand and optimally manage parathyroid disorders and bone abnormalities in CKD patients.
生物活性甲状旁腺激素（PTH）的测量对于慢性肾脏病（CKD）患者继发性甲状旁腺功能亢进及其相关骨病的优化管理至关重要。为此，在过去40年里已开发出三代特异性越来越高的PTH检测方法。然而，迄今为止，尽管第二代PTH检测方法已被证明会与具有部分保留N结构的大PTH片段（主要是PTH(7 - 84)）发生交叉反应，但只有第二代PTH检测方法得到了最广泛的应用。新开发的第三代PTH检测方法被认为是测量PTH(1 - 84)的最特异方法，但其临床实用性仍存在争议。最近，这些检测方法也被证明会与一种新的N形式的PTH发生反应，这种PTH已在严重甲状旁腺功能亢进和甲状旁腺癌患者中被鉴定出来。该领域的不断研究极大地增进了我们对PTH循环分子形式及其在与CKD相关的骨异常中的病理生理作用的理解。然而，由于诸如PTH作为骨转换替代标志物的可靠性、采用第三代PTH检测方法的实用性以及N - PTH和其他PTH片段的未知生物学意义等关键问题，开发一种理想的PTH检测方法仍然困难重重。探索这些问题的进一步研究对于理解和优化管理CKD患者的甲状旁腺疾病和骨异常至关重要。
