Malberti F, Corradi B, Pagliari B, Romanini D, Gazo A, Sidoti A, Baretta A, Bellazzi R, Imbasciati E
Servizi di Nefrologia e Dialisi, Ospedale Maggiore, Lodi, Italy.
Perit Dial Int. 1993;13 Suppl 2:S476-9.
A high incidence of adynamic bone disease not related to aluminum intoxication has been reported in continuous ambulatory peritoneal dialysis (CAPD). Since reduced parathyroid hormone (PTH) secretion may predispose to adynamic bone, we investigated whether parathyroid gland sensitivity may be depressed in CAPD in comparison with hemodialysis (HD). Thus we determined parathyroid function by the evaluation of the PTH-ionized calcium (ICa) relationship, which was obtained inducing hypocalcemia and hypercalcemia in 19 CAPD and 18 HD patients with biochemical and histological evidence of mild (MILD) or severe (OF) hyperparathyroidism, but negative stainable bone aluminum. Either CAPD or HD patients with OF showed a shift to the right of the sigmoidal PTH-ICa curve in comparison with patients with MILD, greater set point of calcium, and maximal PTH stimulation and inhibition. The PTH-ICa curve and the other parathyroid function parameters were not different in CAPD and HD patients within the same bone histological group. In conclusion, our data document that parathyroid gland activity is stimulated either in CAPD and HD patients with OF, but is not depressed in CAPD patients in comparison with HD patients.
据报道，在持续性非卧床腹膜透析（CAPD）中，与铝中毒无关的动力缺失性骨病发生率较高。由于甲状旁腺激素（PTH）分泌减少可能易导致动力缺失性骨病，我们研究了与血液透析（HD）相比，CAPD患者甲状旁腺的敏感性是否会降低。因此，我们通过评估PTH-离子钙（ICa）关系来确定甲状旁腺功能，该关系是在19例CAPD患者和18例HD患者中通过诱导低钙血症和高钙血症获得的，这些患者有生化和组织学证据显示为轻度（MILD）或重度（OF）甲状旁腺功能亢进，但骨铝染色阴性。与MILD患者相比，OF的CAPD或HD患者的S形PTH-ICa曲线向右移动，钙设定点更高，PTH最大刺激和抑制作用更强。在同一骨组织学组内，CAPD和HD患者的PTH-ICa曲线及其他甲状旁腺功能参数并无差异。总之，我们的数据表明，OF的CAPD和HD患者的甲状旁腺活性均受到刺激，但与HD患者相比，CAPD患者的甲状旁腺活性并未降低。
