Fajtova V T, Sayegh M H, Hickey N, Aliabadi P, Lazarus J M, LeBoff M S
Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts 02115, USA.
Calcif Tissue Int. 1995 Nov;57(5):329-35. doi: 10.1007/BF00302067.
To define the onset of the rise in intact parathyroid hormone (PTH) levels in renal insufficiency, we conducted a cross-sectional study of parameters of mineral metabolism in patients with varying degrees of renal impairment. Using an immunoradiometric assay to measure intact PTH levels, we found elevations in intact PTH levels as creatinine clearance approaches 60 ml/minute (serum creatinine near 1.8) and a significant inverse relationship between indices of renal function and intact PTH levels (r = -0.60, P < 0.001 for intact PTH and creatinine clearance.) Calcium and phosphate levels correlate less strongly with the degree of hyperparathyroidism (r = -0.39, P < 0.001 for total calcium; r = 0.31, P < 0.05 for phosphate). As a group, only patients with severe renal failure (creatinine clearance < 20 ml/minute) had 1,25-dihydroxyvitamin D levels below normal (11 +/- 4 [SEM] pg/dl, normal range 15-60). Intact and n-terminal PTH measurements correlate well in this patient population with varying degrees of renal insufficiency (r = 0.9, P < 0.001). Intact PTH can be elevated in patients with mild to moderate renal insufficiency, thus efforts to prevent the development of secondary hyperparathyroidism in renal failure should be undertaken early in the course of renal insufficiency.
为了确定肾功能不全患者中完整甲状旁腺激素（PTH）水平升高的起始点，我们对不同程度肾功能损害患者的矿物质代谢参数进行了一项横断面研究。使用免疫放射分析方法测量完整PTH水平，我们发现当肌酐清除率接近60 ml/分钟（血清肌酐接近1.8）时，完整PTH水平升高，并且肾功能指标与完整PTH水平之间存在显著的负相关关系（完整PTH与肌酐清除率的r = -0.60，P < 0.001）。钙和磷水平与甲状旁腺功能亢进程度的相关性较弱（总钙的r = -0.39，P < 0.001；磷的r = 0.31，P < 0.05）。总体而言，只有严重肾衰竭（肌酐清除率 < 20 ml/分钟）的患者1,25 - 二羟维生素D水平低于正常（11 ± 4 [标准误] pg/dl，正常范围15 - 60）。在不同程度肾功能不全的患者群体中，完整PTH和N端PTH测量结果相关性良好（r = 0.9，P < 0.001）。轻度至中度肾功能不全患者的完整PTH可能会升高，因此应在肾功能不全病程早期就努力预防肾衰竭患者继发性甲状旁腺功能亢进的发生。
