Hasenmajer Valeria, Puliani Giulia, Minnetti Marianna, Sbardella Emilia, Mastroianni Claudio M, D'Ettorre Gabriella, Isidori Andrea M, Gianfrilli Daniele
Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
Oncological Endocrinology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
Adv Exp Med Biol. 2022;1369:17-32. doi: 10.1007/5584_2021_629.
Parathyroid disorders are characterized by alterations in calcium and phosphate homeostasis due to inappropriately high or low levels of parathyroid hormone (PTH). Despite PTH receptor type 1 has been described in almost all immune lineages and calcium signalling has been confirmed as a crucial mediator for immune response, in vitro studies on the physiological interactions between PTH and immunity are conflicting and not representative of the clinical scenarios seen in patients with parathyroid disorders. Infectious diseases are among the main causes of increased morbidity and mortality in patients with secondary hyperparathyroidism and chronic kidney disease. More, immune alterations have been described in primary hyperparathyroidism. Recent studies have unveiled an increased risk of infections also in hypoparathyroidism, suggesting that not only calcium, but also physiological levels of PTH may be necessary for a proper immune response. Finally, calcium/phosphate imbalance could affect negatively the prognosis of infectious diseases. Our review aimed to collect available data on infectious disease prevalence in patients with parathyroid disorders and new evidence on the role of PTH and calcium in determining the increased risk of infections observed in these patients.
甲状旁腺疾病的特征是由于甲状旁腺激素（PTH）水平异常升高或降低，导致钙和磷稳态改变。尽管在几乎所有免疫谱系中都已描述了1型PTH受体，并且钙信号已被确认为免疫反应的关键介质，但关于PTH与免疫之间生理相互作用的体外研究结果相互矛盾，且不能代表甲状旁腺疾病患者的临床情况。传染病是继发性甲状旁腺功能亢进和慢性肾脏病患者发病率和死亡率增加的主要原因之一。此外，原发性甲状旁腺功能亢进中也有免疫改变的描述。最近的研究表明，甲状旁腺功能减退患者感染风险也增加，这表明不仅钙，而且生理水平的PTH对于适当的免疫反应可能也是必需的。最后，钙/磷失衡可能会对传染病的预后产生负面影响。我们的综述旨在收集甲状旁腺疾病患者传染病患病率的现有数据，以及关于PTH和钙在确定这些患者感染风险增加中所起作用的新证据。
