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[血钙正常的高甲状旁腺素血症与关节软骨钙质沉着症。69例患者与57例对照的研究]

[Normocalcemic hyperparathormonemia and articular chondrocalcinosis. Study of 69 patients compared to 57 controls].

作者信息

Pawlotsky Y, Catheline M, Delbary M, Berhault J, Louboutin J Y, Chales G, Le Gall J Y

出版信息

Rev Rhum Mal Osteoartic. 1981 Dec;48(12):799-806.

PMID:7336102
Abstract

The level of parathyroid hormone was measured by heterologue C terminal radio-immunological assay in 69 patients with clinical or radiological manifestations of the type seen in primary articular chondrocalcinosis. They were divided into three groups: P1 with undetermined clinical arthropathies; P2 with sub-chondral and arthosic arthropathies; P3 with radiologically definite chondrocalcinosis. They were compared with 57 control subjects broken up into four groups: T1 with chronic rheumatic arthritis, T2 with low back pain, T3 with primary hyperparathyroidism due to adenoma, and T4 with secondary hyperparathyroidism with renal insufficiency. A form of normocalcemic hyperparathormonaemia was demonstrated in more than one out of two patients in group P1 (15/29). It was seen in three-quarters of the cases in group P2 (12/16). And it was seen in more than a quarter of the cases in group P3 (7/24). This hyperparathormonaemia was statistically significant only in groups P1 and P2 compared to the normals in groups T1 and T2. The results we obtained in this study seem to be in complete concordance with those we obtained earlier in idiopathic hemochromatosis. This hyperparathormonaemia seems to regress with age and is often only discovered when the characteristic articular lesions have appeared. The discovery of normocalcemic hyperparathormonaemia several years before the appearance of the radiological signs of the disease would appear to be an important argument in favour of the diagnosis of early articular chondrocalcinosis. The existence of raised parathyroid hormone in primary articular chondrocalcinosis as well as in idiopathic hemachromatosis is special etiopathogenic interest even if there remain numerous questions concerning its origin and mode of action.

摘要

采用异源C末端放射免疫分析法,对69例有原发性关节软骨钙质沉着症临床或放射学表现的患者进行甲状旁腺激素水平测定。他们被分为三组:P1组为临床关节病未明确者;P2组为软骨下及关节病性关节病患者;P3组为放射学确诊的软骨钙质沉着症患者。将他们与57名对照者进行比较,对照者分为四组:T1组为慢性风湿性关节炎患者,T2组为腰痛患者,T3组为腺瘤所致原发性甲状旁腺功能亢进患者,T4组为肾功能不全所致继发性甲状旁腺功能亢进患者。P1组超过二分之一的患者(15/29)表现出一种正常血钙性甲状旁腺激素血症。P2组四分之三的病例(12/16)出现该症状。P3组超过四分之一的病例(7/24)出现该症状。与T1组和T2组的正常对照相比,这种甲状旁腺激素血症仅在P1组和P2组具有统计学意义。我们在本研究中获得的结果似乎与我们早期在特发性血色素沉着症中获得的结果完全一致。这种甲状旁腺激素血症似乎会随着年龄增长而消退,且通常仅在特征性关节病变出现时才被发现。在疾病放射学征象出现前数年发现正常血钙性甲状旁腺激素血症,似乎是支持早期关节软骨钙质沉着症诊断的一个重要依据。原发性关节软骨钙质沉着症以及特发性血色素沉着症中甲状旁腺激素升高的存在,即使关于其起源和作用方式仍有许多问题,但仍具有特殊的病因学意义。

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