Department of Thyroid and Bone Mineral Diseases, Clinical Center of Endocrinology, Medical University, Sofia, Bulgaria.
Nephrol Dial Transplant. 2012 Jan;27(1):76-80. doi: 10.1093/ndt/gfr590. Epub 2011 Oct 19.
The recently developed non-invasive high-intensity focussed ultrasound (HIFU) technique for the destruction of parathyroid adenomas could also be of interest for the treatment of secondary hyperparathyroidism (SHP) in patients with chronic kidney disease (CKD). We conducted a pilot study using this method.
Five chronic haemodialysis patients with severe SHP underwent one to three HIFU treatments, respectively. They had at least one or two enlarged parathyroid glands, which were accessible to this technique.
In Patients 1-I and 5-V, serum intact parathyroid hormone (iPTH) could be successfully reduced in the long run. In Patient 3-N, serum iPTH decreased dramatically down to the normal range but increased again subsequently. In Patients 2-E and 4-D, transient reductions in serum iPTH were also obtained but HIFU failed to correct SHP during follow-up. Serum total calcium and phosphorus decreased in four among the five patients, either transiently or permanently. Serum total alkaline phosphatases were reduced in four of five patients. Side effects included local oedema, transient impairment of vocal cord mobility and bitonal voice.
HIFU treatment may be of help in controlling SHP in selected patients with CKD. Further experience is clearly needed.
最近开发的用于破坏甲状旁腺瘤的非侵入性高强度聚焦超声（HIFU）技术，对于治疗慢性肾脏病（CKD）患者的继发性甲状旁腺功能亢进症（SHP）也可能具有一定的意义。我们进行了一项使用该方法的初步研究。
五名患有严重 SHP 的慢性血液透析患者分别接受了一至三次 HIFU 治疗。他们至少有一个或两个可以进行该技术的肿大的甲状旁腺。
在患者 1-I 和 5-V 中，血清完整甲状旁腺激素（iPTH）可以长期成功降低。在患者 3-N 中，血清 iPTH 急剧下降至正常范围，但随后再次升高。在患者 2-E 和 4-D 中，血清 iPTH 也出现了短暂的降低，但在随访期间 HIFU 未能纠正 SHP。在五名患者中的四名中，血清总钙和磷要么暂时，要么永久性地降低。五名患者中的四名血清总碱性磷酸酶降低。副作用包括局部水肿、声带活动度短暂受损和双音发声。
HIFU 治疗可能有助于控制选定的 CKD 患者的 SHP。显然需要进一步的经验。
