KDIGO原发性甲状旁腺功能亢进症中肾小球滤过率和甲状旁腺激素分泌的分类

KDIGO CATEGORIES OF GLOMERULAR FILTRATION RATE AND PARATHYROID HORMONE SECRETION IN PRIMARY HYPERPARATHYROIDISM.

作者信息

Tassone Francesco, Gianotti Laura, Baffoni Claudia, Pellegrino Micaela, Castellano Elena, Borretta Giorgio

出版信息

Endocr Pract. 2015 Jun;21(6):629-33. doi: 10.4158/EP14537.OR. Epub 2015 Feb 25.

DOI:10.4158/EP14537.OR

PMID:25716636

Abstract

OBJECTIVE

The recent Fourth Workshop on the Management of Asymptomatic primary hyperparathyroidism (PHPT) maintained the threshold of 60 mL/min for decreased renal function, below which surgery is recommended. This study investigated the relationship between different stages of renal insufficiency and parathyroid hormone (PTH) levels in an updated case series of PHPT patients.

METHODS

This was a retrospective, cross-sectional study involving 379 consecutive PHPT patients. Biochemical evaluation included total and ionized serum calcium, phosphate, creatinine, immunoreactive intact PTH, and 25-hydroxyvitamin D3 (25[OH]D3) levels in the fasting state. Glomerular filtration rate (GFR) was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.

RESULTS

Mean CKD-EPI estimated GFR was 81.9 ± 20.3 mL/min/1.73 m(2), and median GFR was 84.0 mL/min/1.73 m(2) (interquartile range, 26.8 mL/min/1.73 m(2)). The patients were divided into 5 groups according to the Kidney Disease: Improving Global Outcomes 2012 guidelines: group 1 with normal or increased GFR (>90 mL/min/1.73 m(2)); group 2 with mild GFR decrease (60 to 89 mL/min/1.73 m(2)); group 3a with mild to moderate GFR decrease (45 to 59 mL/min/1.73 m(2)); group 3b with moderate to severe GFR decrease (30 to 44 mL/min/1.73 m(2)); and group 4 with severe GFR decrease (<30 mL/min/1.73 m(2)). Among the 5 groups of patients, serum calcium levels were different (P = .025), whereas 25(OH)D3 levels were not (P = .36). PTH levels were comparable across groups 1 through 3a, but they were significantly higher in groups 3b and 4 (P<.0001).

CONCLUSION

In our series of PHPT patients, PTH levels did not rise as a result of renal impairment until GFR decreased below 45 mL/min/1.73 m(2).

摘要

目的

近期召开的第四届无症状原发性甲状旁腺功能亢进症（PHPT）管理研讨会维持了将肾功能下降阈值设定为60 mL/min的标准，低于该阈值时建议进行手术。本研究在一组更新的PHPT患者病例系列中调查了肾功能不全不同阶段与甲状旁腺激素（PTH）水平之间的关系。

方法

这是一项回顾性横断面研究，纳入了379例连续的PHPT患者。生化评估包括空腹状态下的血清总钙、离子钙、磷酸盐、肌酐、免疫反应性完整PTH以及25-羟维生素D3（25[OH]D3）水平。采用慢性肾脏病流行病学协作组（CKD-EPI）方程估算肾小球滤过率（GFR）。

结果

CKD-EPI估算的平均GFR为81.9±20.3 mL/min/1.73 m²，GFR中位数为84.0 mL/min/1.73 m²（四分位间距为26.8 mL/min/1.73 m²）。根据《2012年改善全球肾脏病预后组织指南》，将患者分为5组：1组GFR正常或升高（>90 mL/min/1.73 m²）；2组GFR轻度下降（60至89 mL/min/1.73 m²）；3a组GFR轻度至中度下降（45至59 mL/min/1.73 m²）；3b组GFR中度至重度下降（30至44 mL/min/1.73 m²）；4组GFR重度下降（<30 mL/min/1.73 m²）。在这5组患者中，血清钙水平存在差异（P = 0.025），而25(OH)D3水平无差异（P = 0.36）。1至3a组的PTH水平相当，但3b组和4组的PTH水平显著更高（P<0.0001）。