Kaplan R A, Haussler M R, Deftos L J, Bone H, Pak C Y
J Clin Invest. 1977 May;59(5):756-60. doi: 10.1172/JCI108696.
The cuase for the intestinal hyperabsorptionof calcium (Ca) in various forms of hypercalciurias was explored by a careful measurement of plasma 1 alpha, 25-dihydroxycholecalciferol [1 alpha, 25-(OH)I D] and by an assessment of intestinal Ca absorption and of parathyroid function. In 18 cases of primary hyperparathyroidism (PHPT), the mean plasma concentration of 1 alpha, 25-(OH)2D was significantly increased (4.9 +/- 2.2 SD ng/dl vs. 3.4 +/- 0.9 ng/dl for the control group), and was significantly correlated with fractional Ca absorption (alpha) (r = 0.80, P less than 0.001). Plasma 1 alpha, 25-(OH)2D was also correlated with urinary Ca (P less than 0.05), but not with serum Ca or phosphorus (P), P clearance, urinary cyclic AMP, or serum immunoreactive parathyroid hormone. In 21 cases of absorptive hypercalciuria (AH), plasma 1 alpha, 25-(OH)2D was elevated in one-third of cases, and the mean value of 4.5 +/- 1.1 ng/dl was significantly higher than that of the control group (P less than 0.01). Since relative hypoparathyroidism may be present, the normal absolute value of plasma 1 alpha, 25-(OH)2D, found in two-thirds of cases of AH, may be considered to be inappropriately high. Moreover, in the majority of cases of AH, the data points relating plasma 1 alpha, 25-(OH)2D and alpha fell within 95% confidence limits of values found in non-AH groups (including PHPT). The results suggest that the intestinal hyperabsorption of Ca in PHPT aw AH may be vitamin D dependent. However, the disturbance in vitamin D metabolism may not be the sole cause for the high Ca absorption in AH, since in some patients with AH, the intestinal Ca absorption appears to be inapp
通过仔细测定血浆1α,25 - 二羟胆钙化醇[1α,25-(OH)₂D]以及评估肠道钙吸收和甲状旁腺功能，探讨了各种形式高钙尿症中肠道钙过度吸收的原因。在18例原发性甲状旁腺功能亢进症（PHPT）患者中，血浆1α,25-(OH)₂D的平均浓度显著升高（4.9±2.2标准差ng/dl，对照组为3.4±0.9 ng/dl），且与钙吸收分数（α）显著相关（r = 0.80，P＜0.001）。血浆1α,25-(OH)₂D也与尿钙相关（P＜0.05），但与血清钙或磷（P）、P清除率、尿环磷酸腺苷或血清免疫反应性甲状旁腺激素无关。在21例吸收性高钙尿症（AH）患者中，三分之一的病例血浆1α,25-(OH)₂D升高，平均值为4.5±1.1 ng/dl，显著高于对照组（P＜0.01）。由于可能存在相对甲状旁腺功能减退，在三分之二的AH病例中发现的血浆1α,25-(OH)₂D正常绝对值可能被认为过高。此外，在大多数AH病例中，血浆1α,25-(OH)₂D与α相关的数据点落在非AH组（包括PHPT）发现的值的95%置信区间内。结果表明，PHPT和AH中肠道钙的过度吸收可能依赖维生素D。然而，维生素D代谢紊乱可能不是AH中高钙吸收的唯一原因，因为在一些AH患者中，肠道钙吸收似乎不恰当。
