Elbers Laura P B, Wijnberge Marije, Meijers Joost C M, Poland Dennis C W, Brandjes Dees P M, Fliers Eric, Gerdes Victor E A
Department of Internal MedicineMedical Center Slotervaart, Amsterdam, the Netherlands.
Department of Vascular MedicineAcademic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Endocr Connect. 2018 Feb;7(2):325-333. doi: 10.1530/EC-17-0249. Epub 2018 Jan 9.
Abnormal coagulation tests have been observed in patients with primary hyperparathyroidism (HPT) suggesting a prothrombotic effect of parathyroid hormone (PTH). Vitamin D deficiency (VIDD) is the most frequent cause of secondary HPT. Aim of our study was to investigate the influence of HPT secondary to moderate-to-severe VIDD and vitamin D replacement on the coagulation and fibrinolysis system.
Prospective cohort study of patients with vitamin D <25 nmol/L with and without HPT, and a control group of patients on vitamin D suppletion. At baseline and after 2 months of vitamin D suppletion (900,000 IU in 2 months), endocrine and coagulation markers were measured.
59 patients with VIDD of which 34 had secondary HPT and 36 controls were included. After 2 months of suppletion, vitamin D increased by 399% (VIDD with HPT), 442% (all patients with VIDD) and 6% (controls). PTH decreased by 34% (VIDD with HPT, < 0.01 for decrease), 32% (all VIDD, < 0.01) and increased by 8% in the controls (-values: <0.01 for relative changes between VIDD with HPT or all VIDD patients vs controls). Relative changes in PT, aPTT, fibrinogen, Von Willebrand factor, factors VII, VIII and X, thrombin generation, TAFI, clot-lysis time and d-dimer were not different between patients with VIDD with HPT or all VIDD vs controls.
Secondary HPT due to VIDD does not have a prothrombotic effect. In contrast with previous reports, PTH does not seem to influence coagulation or fibrinolysis, which is relevant because of the high prevalence of VIDD.
原发性甲状旁腺功能亢进症（HPT）患者的凝血试验异常，提示甲状旁腺激素（PTH）具有促血栓形成作用。维生素D缺乏（VIDD）是继发性HPT最常见的原因。我们研究的目的是探讨中度至重度VIDD继发的HPT及维生素D替代治疗对凝血和纤溶系统的影响。
对维生素D<25 nmol/L且伴有或不伴有HPT的患者进行前瞻性队列研究，并设立一组补充维生素D的对照组。在基线时以及补充维生素D 2个月后（2个月内补充900,000 IU），测量内分泌和凝血指标。
纳入59例VIDD患者，其中34例有继发性HPT，36例为对照组。补充2个月后，维生素D升高了399%（伴有HPT的VIDD患者）、442%（所有VIDD患者）和6%（对照组）。PTH下降了34%（伴有HPT的VIDD患者，下降<0.01）、32%（所有VIDD患者，<0.01），对照组升高了8%（HPT的VIDD患者或所有VIDD患者与对照组之间相对变化的P值：<0.01）。伴有HPT的VIDD患者或所有VIDD患者与对照组相比，凝血酶原时间（PT）、活化部分凝血活酶时间（aPTT）、纤维蛋白原、血管性血友病因子、因子VII、VIII和X、凝血酶生成、凝血酶激活的纤溶抑制物（TAFI）、血块溶解时间和D-二聚体的相对变化无差异。
VIDD继发的继发性HPT不具有促血栓形成作用。与之前的报道相反，PTH似乎不影响凝血或纤溶，鉴于VIDD的高患病率，这一点具有重要意义。
