Massimetti Carlo, Imperato Gea, Feriozzi Sandro
Centro di Riferimento di Nefrologia e Dialisi, Ospedale Belcolle, Viterbo.
G Ital Nefrol. 2019 Feb;36(1).
Left ventricular hypertrophy (LVH) is common in renal transplant recipients (RTRs), and persistent secondary hyperparathyroidism (SHPT) is considered to be one of the main causes of its pathogenesis. In this study we evaluated if the control of SHPT with paricalcitol is associated with a reduction of LVH in RTRs.
For this purpose we selected 24 RTRs with LVH and SHPT. Secondary hyperparathyroidism was defined as PTH levels 1.5 times higher than the high normal limits, while LVH was defined as a left ventricular mass index (LVMi) >95g/m2 in females, and >115g/m2 in males. Treatment with paricalcitol started at mean dose of 1µg/day and lasted 18 months. The dose of paricalcitol was reduced to 1µg on the other day when serum calcium was >10.5mg/dl and/or fractional excretion of calcium was >0.020%; administration was temporarily stopped when serum calcium was >11 mg/dl.
At follow-up PTH levels decreased from 198 ± 155 to 105 ± 43pg/ml, and LVMi decreased from 134 ± 21 to 113 ± 29g/m2; the presence of LVH decreased from 100% at baseline to 54% at F-U. Serum calcium levels showed a modest and not significant increase. Renal function was stable in all patients.
Secondary hyperparathyroidism seems to play an important role in the development and maintenance of LVH and its correction with paricalcitol has a favorable impact on its progression.
左心室肥厚（LVH）在肾移植受者（RTRs）中很常见，持续性继发性甲状旁腺功能亢进（SHPT）被认为是其发病机制的主要原因之一。在本研究中，我们评估了使用帕立骨化醇控制SHPT是否与RTRs中LVH的减轻相关。
为此，我们选择了24例患有LVH和SHPT的RTRs。继发性甲状旁腺功能亢进定义为甲状旁腺激素（PTH）水平高于正常上限的1.5倍，而LVH定义为女性左心室质量指数（LVMi）>95g/m2，男性>115g/m2。帕立骨化醇治疗开始时的平均剂量为1μg/天，持续18个月。当血清钙>10.5mg/dl和/或钙分数排泄>0.020%时，帕立骨化醇剂量隔天减至1μg；当血清钙>11mg/dl时，暂时停药。
随访时，PTH水平从198±155降至105±43pg/ml，LVMi从134±21降至113±29g/m2；LVH的发生率从基线时的100%降至随访时的54%。血清钙水平有适度但不显著的升高。所有患者的肾功能稳定。
继发性甲状旁腺功能亢进似乎在LVH的发生和维持中起重要作用，用帕立骨化醇纠正继发性甲状旁腺功能亢进对其进展有有利影响。
