Juttmann J R, Buurman C J, De Kam E, Visser T J, Birkenhäger J C
Clin Endocrinol (Oxf). 1981 Mar;14(3):225-36. doi: 10.1111/j.1365-2265.1981.tb00191.x.
In forty-two patients with chronic renal failure (CRF), serum concentrations of 25-hydroxy-cholecalciferol (25-OHCC), 24,25-dihydroxy-cholecalciferol (24,25-OH2CC) and 1,25-dihydroxy-cholecalciferol (1,25-OH2CC) were measured before and during intermittent haemodialysis (IHD) and in a few cases also after renal transplantation. 25-OHCC and 24,25-OH2CC were measured by means of a competitive protein binding assay after Sephadex LH20 chromatography and 1,25-OH2CC by means of a radioimmunoassay after Sephadex LH20 and high pressure liquid chromatography (HPLC). In our patients serum values for 25-OHCC and 24,25-OH2CC showed a seasonal fluctuation as in normal individuals. The concentrations in the serum of 24,25-OH2CC and 1,25-OH2CC showed a positive correlation with renal function. With regard to 24,25-OH2CC this correlation was only found for the 24,25-OH2CC:25-OHCC ratio which was used to eliminate the seasonal fluctuation. For both dihydroxylated metabolites subnormal concentrations were found when the creatinine clearance was 40-50 ml/min and lower. It appears that the decrease of the plasma level of these metabolites of Vitamin D precedes (or is concomitant with) the changes in the serum values of calcium (Ca), phosphorus (P) and parathyroid hormone (PTH) and the diminution of the intestinal absorption of Ca. These findings indicate that patients with CRF should be treated at an early stage of the disease with 1 alpha-hydroxy-derivatives of Vitamin D in order to prevent the development of, or to induce the healing of, bone-lesions of renal osteodystrophy.
在42例慢性肾衰竭（CRF）患者中，在间歇性血液透析（IHD）前及透析期间测定了血清25-羟胆钙化醇（25-OHCC）、24,25-二羟胆钙化醇（24,25-OH2CC）和1,25-二羟胆钙化醇（1,25-OH2CC）的浓度，少数病例在肾移植后也进行了测定。25-OHCC和24,25-OH2CC采用葡聚糖凝胶LH20柱层析后竞争性蛋白结合分析法测定，1,25-OH2CC采用葡聚糖凝胶LH20柱层析和高压液相色谱（HPLC）后放射免疫分析法测定。在我们的患者中，血清25-OHCC和24,25-OH2CC值与正常个体一样呈现季节性波动。血清24,25-OH2CC和1,25-OH2CC的浓度与肾功能呈正相关。对于24,25-OH2CC，这种相关性仅在用于消除季节性波动的24,25-OH2CC:25-OHCC比值中发现。当肌酐清除率为40 - 50 ml/min及更低时，两种二羟化代谢产物的浓度均低于正常水平。维生素D这些代谢产物的血浆水平下降似乎先于（或伴随）血清钙（Ca）、磷（P）和甲状旁腺激素（PTH）值的变化以及钙的肠道吸收减少。这些发现表明，CRF患者应在疾病早期用维生素D的1α-羟基衍生物进行治疗，以预防肾性骨营养不良骨病变的发生或促进其愈合。
