原发性甲状旁腺功能亢进患者中的高精氨酸。

Homoarginine in patients with primary hyperparathyroidism.

作者信息

Tomaschitz Andreas, Verheyen Nicolas, Gaksch Martin, Meinitzer Andreas, Pieske Burkert, Kraigher-Krainer Elisabeth, Colantonio Caterina, März Winfried, Schmidt Albrecht, Belyavskiy Evgeny, Rus-Machan Jutta, van Ballegooijen Adriana J, Stiegler Claudia, Amrein Karin, Ritz Eberhard, Fahrleitner-Pammer Astrid, Pilz Stefan

机构信息

Department of Cardiology (AT, NV, BP, EK-K, CC, AS, EB), Medical University of Graz, Graz, Austria; Specialist Clinic for Rehabilitation PV Bad Aussee (AT, JR-M), Bad Aussee, Austria; Medizinische Klinik mit Schwerpunkt Kardiologie (AT, BP, EK-K), Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany; Division of Endocrinology and Metabolism, Department of Internal Medicine (MG, CS, KA, AF-P, SP), Medical University of Graz, Graz, Austria; Clinical Institute of Medical and Chemical Laboratory Diagnostics (AM, WM), Medical University of Graz, Graz, Austria; Synlab-Academy (WM), Synlab services LLC, Mannheim, Germany; Medical Clinic V (Nephrology, Hypertensiology, Endocrinology, Diabetology, Rheumatology) (WM), Ruperto Carola University Heidelberg, Medical Faculty Mannheim, Mannheim, Germany; Department of Epidemiology and Biostatistics (AJvB) and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands; and Department of Medicine, Division of Nephrology (ER), University Hospital Heidelberg, Heidelberg, Germany.

出版信息

Am J Med Sci. 2015 Apr;349(4):306-11. doi: 10.1097/MAJ.0000000000000419.

DOI:10.1097/MAJ.0000000000000419

PMID:25647833

Abstract

BACKGROUND

Low levels of the amino acid homoarginine and parathyroid hormone (PTH) excess are both independently related to an increased risk of cardiovascular morbidity and mortality. Accumulating evidence points to a mutual interplay between homoarginine and PTH. The authors therefore aimed to investigate circulating homoarginine levels in patients with and without primary hyperparathyroidism (PHPT).

METHODS

The authors performed a cross-sectional analysis of serum homoarginine levels in 59 patients with mild and severe PHPT and in 92 control persons matched for age, sex and estimated glomerular filtration rate.

RESULTS

Median PTH and serum homoarginine concentrations were 99.1 (79.7-120.2) pg/mL and 1.16 (0.95-1.66) µmol/L in patients with PHPT (79.7% female; 42.4% with normocalcemia) as compared with 45.8 (36.4-53.9) pg/mL and 1.62 (1.33-2.04) µmol/L in the control group (P < 0.001 for both), respectively. The authors observed no statistically differences between cases and controls for 25-hydroxyvitamin D [25(OH)D], serum albumin, hemoglobin, waist-to-hip ratio, C-reactive protein and NT-pBNP values. Multivariate analysis of covariance revealed that patients with PHPT had significantly lower homoarginine levels than controls (P < 0.001). This difference remained significant after adjusting for multiple confounders such as 25(OH)D, body mass index, LDL cholesterol, albumin, calcium, hemoglobin, smoking status and current antihypertensive medication. The differences of homoarginine levels persisted even after exclusion of patients with estimated glomerular filtration rate <60 mL/min (P = 0.003) and 25(OH)D levels <30 ng/mL (P = 0.001), respectively.

CONCLUSIONS

Patients with PHPT have lower homoarginine levels compared with matched controls irrespective of age, sex, kidney function and 25(OH)D status. Further studies are needed to evaluate whether low homoarginine accounts for higher cardiovascular risk conferred by PTH excess.

摘要

背景

氨基酸高精氨酸水平较低和甲状旁腺激素（PTH）过量均与心血管疾病发病率和死亡率增加独立相关。越来越多的证据表明高精氨酸与PTH之间存在相互作用。因此，作者旨在研究原发性甲状旁腺功能亢进症（PHPT）患者和非PHPT患者的循环高精氨酸水平。

方法

作者对59例轻度和重度PHPT患者以及92例年龄、性别和估计肾小球滤过率相匹配的对照者的血清高精氨酸水平进行了横断面分析。

结果

PHPT患者的PTH中位数和血清高精氨酸浓度分别为99.1（79.7 - 120.2）pg/mL和1.16（0.95 - 1.66）µmol/L（79.7%为女性；42.4%血钙正常），而对照组分别为45.8（36.4 - 53.9）pg/mL和1.62（1.33 - 2.04）µmol/L（两者P均<0.001）。作者观察到病例组和对照组在25 - 羟维生素D [25(OH)D]、血清白蛋白、血红蛋白、腰臀比、C反应蛋白和NT - pBNP值方面无统计学差异。多变量协方差分析显示，PHPT患者的高精氨酸水平显著低于对照组（P < 0.001）。在调整了多个混杂因素（如25(OH)D、体重指数、低密度脂蛋白胆固醇、白蛋白、钙、血红蛋白、吸烟状况和当前的抗高血压药物）后，这种差异仍然显著。即使分别排除估计肾小球滤过率<60 mL/min的患者（P = 0.003）和25(OH)D水平<30 ng/mL的患者（P = 0.001），高精氨酸水平的差异仍然存在。