Hong Yu Ah, Cho Yoo Sun, Kim Sun Woo, Jung Mi Yeon, Lee Eun Ah, Ko Gang Jee, Pyo Heui Jung, Hwang Soon Young, Suh Sangil, Kwon Young Joo
Division of Nephrology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Kidney Blood Press Res. 2015;40(3):277-87. doi: 10.1159/000368503. Epub 2015 May 22.
BACKGROUND/AIMS: Cinacalcet is one of the important treatments of secondary hyperparathyroidism (SHPT). We evaluated the role of computed tomography (CT) for parathyroid glands (PTGs) to determine the response to cinacalcet therapy in dialysis patients.
In study 1, we compared the predictive cutoff values of the largest volume or diameter of PTGs on ultrasonography or CT for achievement of target intact parathyroid hormone (iPTH) level according to K/DOQI guideline after cinacalcet treatment in a single dialysis center. In study 2, the role of the cutoff diameter of PTGs on CT in predicting responsive to cinacalcet therapy was reevaluated in dialysis patients with SHPT in multiple centers.
In study 1, among the total population of 26 patients, the number of patients with baseline iPTH over 600 pg/mL was 16 (61%). In study 2, it was 45 (54%), among 82 patients. In study 1, the number of PTGs equal to or larger than the cutoff value (≥ 11.2 mm) on CT, not ultrasonography, was significantly higher in non-responders than in responders (p=0.038). In study 2, the proportion of patients with PTGs ≥ 11.2 mm on CT was significantly higher in non-responders than responders (p=0.003). Multivariate analysis showed that pretreatment iPTH (odds ratio [OR] 1.498, p=0.003) and the existence of enlarged PTGs on CT (OR 8.940, p=0.015) were significant clinical factors affecting the response to cinacalcet.
The diameter of PTGs on CT could predict the response to cinacalcet in dialysis patients with SHPT.
背景/目的：西那卡塞是继发性甲状旁腺功能亢进症（SHPT）的重要治疗方法之一。我们评估了计算机断层扫描（CT）对甲状旁腺（PTG）的作用，以确定透析患者对西那卡塞治疗的反应。
在研究1中，我们在单个透析中心比较了西那卡塞治疗后，根据K/DOQI指南，超声或CT上PTG的最大体积或直径对于达到目标完整甲状旁腺激素（iPTH）水平的预测临界值。在研究2中，在多个中心对SHPT透析患者重新评估了CT上PTG的临界直径在预测西那卡塞治疗反应方面的作用。
在研究1中，26例患者的总人群中，基线iPTH超过600 pg/mL的患者有16例（61%）。在研究2中，82例患者中有45例（54%）。在研究1中，CT上而非超声上等于或大于临界值（≥11.2 mm）的PTG数量，无反应者显著高于反应者（p = 0.038）。在研究2中，CT上PTG≥11.2 mm的患者比例，无反应者显著高于反应者（p = 0.003）。多变量分析显示，治疗前iPTH（优势比[OR] 1.498，p = 0.003）和CT上存在增大的PTG（OR 8.940，p = 0.015）是影响西那卡塞反应的重要临床因素。
CT上PTG的直径可预测SHPT透析患者对西那卡塞的反应。
