Wang Chih-Chiang, Hsu Yu-Juei, Wu Chia-Chao, Yang Sung-Sen, Chen Giien-Shuen, Lin Shih-Hua, Chu Pauling
Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Clin Nephrol. 2012 Feb;77(2):89-96. doi: 10.10.5414/CN106757.
Both fetuin-A and hyperparathyroidism play crucial roles in vascular calcification (VC) and bone metabolism. However, the correlation between secondary hyperparathyroidism (SHPT), parathyroidectomy (PTX) and fetuin-A levels in dialysis patients has not yet been studied.
For this study, we included 27 consecutive dialysis patients with severe SHPT who underwent total PTX with autotransplantation over a period of 2 years (from Oct 2006 to Sep 2008). Serum ionized calcium (iCa), phosphorus (Pi), bone-specific alkaline phosphatase (bAP), intact parathyroid hormone (iPTH), and fetuin-A were checked basally and 2, 7, 14, 30, and 60 days after PTX.
Two days after PTX, the iPTH, serum iCa, and Pi concentrations significantly decreased. Serum bAP levels gradually increased after PTX, peaked after 14 days (p < 0.05), and then gradually decreased. Serum fetuin-A levels significantly increased during the first 7 days after PTX, peaked 14 days after PTX (0.21 ± 0.05 vs. 0.35 ± 0.07 mg/ml, p < 0.05), and then remained at a stable level 60 days after PTX. There were significant correlations between percentage increase in serum fetuin-A levels and percentage decrease in serum iPTH levels 2 days and 7 days after PTX (r = 0.526, p < 0.01; r = 0.403, p < 0.05, respectively) and correlations between percentage increase in serum fetuin-A levels and percentage decrease in serum iCa levels 30 and 60 days after PTX (r = 0.449, p < 0.05; r = 0.474, p < 0.05, respectively).
Serum fetuin-A significantly increased after PTX in uremic patients with SHPT. The percentage increase in serum fetuin-A after PTX was closely correlated with the percentage decrease in serum iPTH levels immediately after PTX, and with the percentage decrease in serum iCa levels in the later stage after PTX. Further investigations are necessary to further understand the regulation of fetuin-A in dialysis patients with sSHPT.
胎球蛋白-A和甲状旁腺功能亢进在血管钙化（VC）和骨代谢中均起关键作用。然而，尚未研究透析患者继发性甲状旁腺功能亢进（SHPT）、甲状旁腺切除术（PTX）与胎球蛋白-A水平之间的相关性。
在本研究中，我们纳入了27例连续的重度SHPT透析患者，他们在2年期间（从2006年10月至2008年9月）接受了自体移植的全甲状旁腺切除术。在PTX前及PTX后2、7、14、30和60天检测血清离子钙（iCa）、磷（Pi）、骨特异性碱性磷酸酶（bAP）、完整甲状旁腺激素（iPTH）和胎球蛋白-A。
PTX后2天，iPTH、血清iCa和Pi浓度显著降低。PTX后血清bAP水平逐渐升高，14天后达到峰值（p<0.05），然后逐渐降低。PTX后前7天血清胎球蛋白-A水平显著升高，PTX后14天达到峰值（0.21±0.05对0.35±0.07mg/ml，p<0.05），然后在PTX后60天保持稳定水平。PTX后2天和7天血清胎球蛋白-A水平升高百分比与血清iPTH水平降低百分比之间存在显著相关性（r=0.526，p<0.01；r=0.403，p<0.05），PTX后30天和60天血清胎球蛋白-A水平升高百分比与血清iCa水平降低百分比之间存在相关性（r=0.449，p<0.05；r=0.474，p<0.05）。
SHPT尿毒症患者PTX后血清胎球蛋白-A显著升高。PTX后血清胎球蛋白-A升高百分比与PTX后即刻血清iPTH水平降低百分比以及PTX后期血清iCa水平降低百分比密切相关。有必要进一步研究以深入了解sSHPT透析患者中胎球蛋白-A的调节机制。
