Andress D, Felsenfeld A J, Voigts A, Llach F
Kidney Int. 1983 Sep;24(3):364-70. doi: 10.1038/ki.1983.168.
The parathyroid hormone response to hypocalcemia was investigated in hemodialysis patients with osteomalacia and compared to those with osteitis fibrosa. Hypocalcemia was induced during hemodialysis by employing a dialysate devoid of calcium. Patients with osteomalacia had a blunted maximum amino terminal parathyroid hormone response (+/- SD) (0.39 +/- 0.33 vs. 0.87 +/- 0.53 ng/ml, P less than 0.05) and maximum carboxy terminal parathyroid hormone response (+/- SD) (0.36 +/- 0.20 vs. 0.84 +/- 0.47, P less than 0.02) to hypocalcemia. The decline in plasma calcium was greater in patients with osteomalacia at 90 (P less than 0.05), 120 (P less than 0.01), and 150 min (P less than 0.01). In osteomalacia patients the surface density of histologically detectable trabecular bone aluminum correlated directly with the percent relative osteoid volume (P less than 0.005) and inversely with the maximum amino terminal parathyroid hormone response to hypocalcemia (P less than 0.025). These results suggest that hemodialysis patients with osteomalacia have diminished secretion of parathyroid hormone and a decreased ability to restore plasma calcium homeostasis during hypocalcemia.
对患有骨软化症的血液透析患者甲状旁腺激素对低钙血症的反应进行了研究，并与患有纤维性骨炎的患者进行了比较。在血液透析期间，通过使用不含钙的透析液诱导低钙血症。骨软化症患者对低钙血症的最大氨基末端甲状旁腺激素反应（±标准差）（0.39±0.33对0.87±0.53 ng/ml，P<0.05）和最大羧基末端甲状旁腺激素反应（±标准差）（0.36±0.20对0.84±0.47，P<0.02）减弱。在90分钟（P<0.05）、120分钟（P<0.01）和150分钟（P<0.01）时，骨软化症患者血浆钙的下降幅度更大。在骨软化症患者中，组织学上可检测到的小梁骨铝的表面密度与相对类骨质体积百分比直接相关（P<0.005），与对低钙血症的最大氨基末端甲状旁腺激素反应呈负相关（P<0.025）。这些结果表明，患有骨软化症的血液透析患者甲状旁腺激素分泌减少，在低钙血症期间恢复血浆钙稳态的能力下降。
