Quarles L D
Department of Medicine, Duke University Medical Center, Durham, North Carolina 27710.
Am J Physiol. 1990 Apr;258(4 Pt 1):E576-81. doi: 10.1152/ajpendo.1990.258.4.E576.
Excess bone aluminum accumulates in uremic subjects after parathyroidectomy. To evaluate whether decreased bone remodeling caused by parathyroidectomy augments bone aluminum deposition, we administered aluminum chloride (0.75 mg/kg iv 3 times/wk) or vehicle to thyroparathyroidectomized (TPTX) and sham-operated (Sham) nonuremic beagles for 8 wk. TPTX alone effectively lowered plasma parathyroid hormone concentrations (8.2 +/- 2.8 vs. 27 +/- 2.2 pg/ml) and consequently suppressed bone remodeling, as evidenced by the diminished resorptive surface (0.8 +/- 0.3 vs. 4.0 +/- 0.5%), osteoid surface (0.5 +/- 0.2 vs. 13.3 +/- 2.3%), and bone formation rate (1.8 +/- 0.6 vs. 15.5 +/- 2.2%/yr) compared with untreated Shams. Aluminum treatment resulted in no further suppression of bone remodeling in TPTX dogs and did not cause osteomalacia. Aluminum-treated TPTX dogs, however, accumulated much less total bone (28.1 +/- 4.5 micrograms/g) and surface aluminum (3.8 +2- 1.4%) than similarly treated Shams (61.4 +/- 5.6 micrograms/g; 12.2 +/- 2.7%, respectively) despite displaying higher plasma aluminum concentrations (1,209 +/- 330 vs. 181 +/- 18 micrograms/l). These observations illustrate that diminished bone turnover retards rather than augments bone aluminum accumulation. Thus bone aluminum deposition after parathyroidectomy in uremic subjects is not likely to be the result of passive aluminum accumulation on inactive bone surfaces. Further studies are needed to determine whether factors, such as prior bone aluminum accumulation and/or the degree of preexistent hyperosteoidosis, modulate aluminum accumulation after parathyroidectomy.
甲状旁腺切除术后,尿毒症患者体内会蓄积过量的骨铝。为评估甲状旁腺切除引起的骨重塑减少是否会增加骨铝沉积,我们对甲状腺甲状旁腺切除(TPTX)和假手术(Sham)的非尿毒症比格犬静脉注射氯化铝(0.75mg/kg,每周3次)或赋形剂,持续8周。单独TPTX可有效降低血浆甲状旁腺激素浓度(8.2±2.8对27±2.2pg/ml),从而抑制骨重塑,与未治疗的假手术组相比,骨吸收表面(0.8±0.3对4.0±0.5%)、类骨质表面(0.5±0.2对13.3±2.3%)和骨形成率(1.8±0.6对15.5±2.2%/年)均降低。铝治疗并未进一步抑制TPTX犬的骨重塑,也未导致骨软化症。然而,尽管铝治疗的TPTX犬血浆铝浓度较高(1209±330对181±18μg/l),但其总骨铝(28.1±4.5μg/g)和表面铝(3.8±1.4%)的蓄积量远低于类似治疗的假手术组(分别为61.4±5.6μg/g;12.2±2.7%)。这些观察结果表明,骨转换减少会延缓而非增加骨铝蓄积。因此,尿毒症患者甲状旁腺切除术后的骨铝沉积不太可能是铝在无活性骨表面被动蓄积的结果。需要进一步研究以确定诸如先前的骨铝蓄积和/或先前存在的骨肥厚程度等因素是否会调节甲状旁腺切除术后的铝蓄积。