Hanley D A, Sherwood L M
Med Clin North Am. 1978 Nov;62(6):1319-39. doi: 10.1016/s0025-7125(16)31739-4.
The secondary hyperparathyroidism of chronic renal failure is a result of many factors which result in chronic stimulation of parathyroid hormone secretion and secondary hyperplasia of the parathyroid glands. The secretion and metabolism of parathyroid hormone and its fragments in chronic renal failure are complex and only partially understood. Constant elevated levels of PTH contribute to bone disease and other clinical features of chronic renal failure. Calcium supplementation, high calcium dialysis, control of plasma phosphate and judicious use of the vitamin D metabolites can, to a large extent, prevent or control the development of secondary hyperparathyroidism. Subtotal parathyroidectomy or total parathyroidectomy with autotransplantation is indicated in certain cases, sometimes on an emergency basis. Prevention of postoperative hypocalcemia requires careful management. Successful renal transplantation is usually associated with gradual healing of the bone disease and slow, but sometimes incomplete involution of the parathyroid hyperplasia.
慢性肾衰竭的继发性甲状旁腺功能亢进是多种因素导致甲状旁腺激素分泌长期受刺激及甲状旁腺继发性增生的结果。慢性肾衰竭时甲状旁腺激素及其片段的分泌和代谢较为复杂，目前仅部分为人所知。甲状旁腺激素持续升高会导致骨病及慢性肾衰竭的其他临床特征。补充钙剂、进行高钙透析、控制血浆磷水平以及合理使用维生素D代谢产物，在很大程度上可预防或控制继发性甲状旁腺功能亢进的发展。在某些情况下，有时是紧急情况下，需要进行甲状旁腺次全切除术或甲状旁腺全切除术加自体移植。预防术后低钙血症需要精心管理。成功的肾移植通常伴随着骨病的逐渐愈合以及甲状旁腺增生的缓慢但有时不完全消退。
