Yamada Shunsuke, Taniguchi Masatomo, Tokumoto Masanori, Tsuruya Kazuhiko, Hirakata Hideki, Iida Mitsuo
Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.
Ther Apher Dial. 2010 Aug 1;14(4):424-31. doi: 10.1111/j.1744-9987.2010.00817.x.
The K/DOQI clinical practice guidelines recommend vitamin D therapy should be started when the intact parathyroid hormone (iPTH) exceeds 300 pg/mL in patients with secondary hyperparathyroidism. To examine whether the effect of vitamin D therapy on mineral metabolism and parathyroid gland growth varies according to the stage of secondary hyperparathyroidism and iPTH level, 47 patients with secondary hyperparathyroidism received either intravenous or pulse oral vitamin D therapy. The patients were divided into two groups based on the iPTH level at the start of vitamin D therapy: the P(<300) group (N = 23) with iPTH <300 pg/mL; and the P(>or=300) group (N = 24) with iPTH >or=300 pg/mL. We examined serial changes in several serum mineral parameters and parathyroid gland volume and the cumulative incidence of parathyroidectomy in the first two years. Serum calcium, phosphorus, calcium-phosphorus product, and iPTH levels of the P(>or=300) group were significantly higher than those of the P(<300) group, and could not be maintained within the target ranges set by the K/DOQI guidelines. In contrast, the serum levels of phosphorus, calcium-phosphorus product, and iPTH were maintained within the target ranges and the parathyroid gland did not enlarge in the P(<300) group. The cumulative incidence of parathyroidectomy in the P(>or=300) group was significantly higher than in the P(<300) group. Early intervention with intravenous or pulse oral vitamin D therapy at serum iPTH <300 pg/mL can control serum phosphorus, calcium-phosphorus product, and PTH levels to the target ranges and slow the progression of secondary hyperparathyroidism.
美国肾脏病基金会（K/DOQI）临床实践指南建议，对于继发性甲状旁腺功能亢进患者，当血清完整甲状旁腺激素（iPTH）超过300 pg/mL时应开始维生素D治疗。为了研究维生素D治疗对矿物质代谢和甲状旁腺生长的影响是否因继发性甲状旁腺功能亢进的阶段和iPTH水平而异，47例继发性甲状旁腺功能亢进患者接受了静脉或脉冲口服维生素D治疗。根据维生素D治疗开始时的iPTH水平，将患者分为两组：iPTH<300 pg/mL的P(<300)组（N = 23）；iPTH≥300 pg/mL的P(≥300)组（N = 24）。我们检查了前两年中几个血清矿物质参数和甲状旁腺体积的系列变化以及甲状旁腺切除术的累积发生率。P(≥300)组的血清钙、磷、钙磷乘积和iPTH水平显著高于P(<300)组，且无法维持在K/DOQI指南设定的目标范围内。相比之下，P(<300)组的磷、钙磷乘积和iPTH血清水平维持在目标范围内，甲状旁腺未增大。P(≥300)组甲状旁腺切除术的累积发生率显著高于P(<300)组。在血清iPTH<300 pg/mL时早期采用静脉或脉冲口服维生素D治疗可将血清磷、钙磷乘积和PTH水平控制在目标范围内，并减缓继发性甲状旁腺功能亢进的进展。
