Berland Y, Charbit M, Henry J F, Toga M, Cano J P, Olmer M
Service de Néphrologie, Hôpital de la Conception, Marseille, France.
Nephrol Dial Transplant. 1988;3(4):417-22. doi: 10.1093/oxfordjournals.ndt.a091690.
In the course of chronic renal failure, aluminium may deposit and accumulate in different tissues. The aluminium content of parathyroid glands was measured in 31 haemodialysis patients at the time of a parathyroidectomy. The values were compared with those obtained from ten control patients with primary hyperparathyroidism without renal failure, and were related to bone remodelling. Of the 31 patients, 27 had a bone biopsy after double tetracycline labelling, at the time of parathyroidectomy. Twenty-one patients had severe hyperparathyroidism, three patients had hyperparathyroidism associated with osteomalacia, three patients had mild hyperparathyroidism with reduced bone formation. Seven patients had bone aluminium deposits, associated with osteomalacia in one case. The parathyroid aluminium was 62 +/- 35.7 (mumol/g glandular dry weight) in haemodialysis patients and 14.3 +/- 6.3 in control patients (P less than 0.001). A significant positive correlation existed between parathyroid aluminium and serum aluminium (P less than 0.01). The parathyroid aluminium was not different in the patients with and without bone aluminium deposits. A weak correlation was found between parathyroid aluminium and plasma parathyroid hormone. A significant negative correlation existed between parathyroid aluminium and osteoblastic surfaces (P less than 0.05), but no correlation was found with bone formation rate at tissue and bone multicellular units levels. We conclude that aluminium accumulates in parathyroid glands of dialysed patients. Severe hyperparathyroidism may coexist with aluminium overload of parathyroid glands. A marked aluminium overload, however, may cut short the course of hyperparathyroidism and may decrease parathyroid function and cellular activity in bone.
在慢性肾衰竭过程中，铝可能在不同组织中沉积和蓄积。对31例接受甲状旁腺切除术的血液透析患者的甲状旁腺铝含量进行了测定。将这些值与10例无肾衰竭的原发性甲状旁腺功能亢进对照患者的值进行比较，并与骨重塑相关联。在这31例患者中，27例在甲状旁腺切除术时进行了双四环素标记后的骨活检。21例患者患有严重甲状旁腺功能亢进，3例患者患有与骨软化症相关的甲状旁腺功能亢进，3例患者患有轻度甲状旁腺功能亢进且骨形成减少。7例患者有骨铝沉积，其中1例与骨软化症相关。血液透析患者的甲状旁腺铝含量为62±35.7（μmol/g腺干重），对照患者为14.3±6.3（P<0.001）。甲状旁腺铝与血清铝之间存在显著正相关（P<0.01）。有和没有骨铝沉积的患者甲状旁腺铝含量无差异。甲状旁腺铝与血浆甲状旁腺激素之间存在弱相关性。甲状旁腺铝与成骨细胞表面之间存在显著负相关（P<0.05），但在组织和骨多细胞单位水平与骨形成率无相关性。我们得出结论，铝在透析患者的甲状旁腺中蓄积。严重甲状旁腺功能亢进可能与甲状旁腺铝过载共存。然而，明显的铝过载可能会缩短甲状旁腺功能亢进的病程，并可能降低甲状旁腺功能和骨细胞活性。
