Winer K K, Yanovski J A, Cutler G B
Developmental Endocrinology Branch of the National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD 20892-1862, USA.
JAMA. 1996 Aug 28;276(8):631-6.
To test the hypothesis that treatment with human parathyroid hormone 1-34 (PTH 1-34) can maintain normal serum calcium without hypercalciuria in patients with hypoparathyroidism.
Randomized crossover trial lasting 20 weeks. Each 10-week arm consisted of a 2-week inpatient dose-adjustment phase followed by an 8-week outpatient phase.
Tertiary care center.
A total of 10 patients with hypoparathyroidism were enrolled consecutively over a 15-month period. Half of the patients were prior National Institutes of Health patients, and the other 5 patients were referred from outside physicians.
A dose of PTH 1-34 was administered each morning by subcutaneous injection. Calcitriol was given orally twice daily with supplemental calcium carbonate.
Serum and urine calcium and phosphorus levels.
Once-daily treatment with PTH 1-34 maintained serum calcium in the normal range with decreased urine calcium excretion (P<.05 at 2 weeks and P<.Ol at 10 weeks) compared with calcitriol treatment. Biochemical markers of bone turnover increased significantly (P<.Ol at 10 weeks) during PTH 1-34 treatment.
Treatment of hypoparathyroidism with PTH 1-34 reduces urine calcium excretion compared with treatment with calcitriol and calcium.
验证甲状旁腺激素1-34（PTH 1-34）治疗可使甲状旁腺功能减退患者维持正常血清钙水平且不伴有高钙尿症这一假设。
为期20周的随机交叉试验。每个为期10周的阶段包括一个为期2周的住院剂量调整期，随后是一个为期8周的门诊期。
三级医疗中心。
在15个月期间连续招募了10例甲状旁腺功能减退患者。其中半数患者曾是美国国立卫生研究院的患者，另外5例患者由外部医生转诊而来。
每天早晨皮下注射一剂PTH 1-34。骨化三醇每日口服两次，并补充碳酸钙。
血清和尿钙、磷水平。
与骨化三醇治疗相比，每日一次PTH 1-34治疗可使血清钙维持在正常范围内，同时尿钙排泄减少（2周时P<0.05，10周时P<0.01）。在PTH 1-34治疗期间，骨转换的生化标志物显著升高（10周时P<0.01）。
与骨化三醇和钙剂治疗相比，PTH 1-34治疗甲状旁腺功能减退可减少尿钙排泄。
