Wang M, Hercz G, Sherrard D J, Maloney N A, Segre G V, Pei Y
Department of Medicine, Veterans Administration Hospital, Seattle, WA, USA.
Am J Kidney Dis. 1995 Nov;26(5):836-44. doi: 10.1016/0272-6386(95)90453-0.
With the markedly reduced usage of aluminum salts in renal failure, parathyroid hormone (PTH) has become the major determinant of currently seen bone disease. Clinicians now must consider what PTH level should be sought. Too low a level may lead to the aplastic bone lesion (low turnover bone), and too high a level may cause osteitis fibrosa. Furthermore, conventional normal PTH levels may not be a suitable target because of the well-known resistance to PTH in uremic patients. In this report, we derive the PTH levels that best distinguish patients with low and high bone formation states from those with normal bone formation in a group of 175 dialysis patients without aluminum toxicity. Using bone histological parameters, we propose that ideally PTH levels should be maintained between 10 pmol/L (100 pg/mL) and 20 to 30 pmol/L (200 to 300 pg/mL) in chronic dialysis patients, levels two to four times the upper limit of values found in normal subjects.
随着肾衰竭患者铝盐使用量的显著减少，甲状旁腺激素（PTH）已成为当前所见骨病的主要决定因素。临床医生现在必须考虑应将PTH水平控制在何种范围。水平过低可能导致再生障碍性骨病变（低转换骨），而水平过高可能会引起纤维性骨炎。此外，由于众所周知的尿毒症患者对PTH的抵抗，传统的正常PTH水平可能并非合适的目标。在本报告中，我们在一组175例无铝中毒的透析患者中，得出了能最佳区分骨形成状态低和高的患者与骨形成正常患者的PTH水平。利用骨组织学参数，我们提出，对于慢性透析患者，理想情况下PTH水平应维持在10 pmol/L（100 pg/mL）至20至30 pmol/L（200至300 pg/mL）之间，该水平是正常受试者上限值的两至四倍。
