Fukagawa M, Yi H, Fukuda N, Kurokawa K
First Department of Internal Medicine, University of Tokyo, Japan.
Artif Organs. 1995 Dec;19(12):1210-4. doi: 10.1111/j.1525-1594.1995.tb02287.x.
Recent clinical and experimental data suggest that the resistance of parathyroid cells to the physiological concentration of calcitriol plays an important role in the pathogenesis and the progression of secondary hyperparathyroidism in chronic renal failure. This resistance is due to the decreased density of the calcitriol receptor in parathyroid cells, which may result from impaired upregulation of calcitriol receptor. Since patients with larger parathyroid glands were more resistance to calcitriol pulse therapy than those with smaller glands and calcitriol receptor density inversely correlated with gland weight, the size of the parathyroid gland may serve as a marker for the degree of resistance to calcitriol. Furthermore, the possible role of phosphorus in the control of parathyroid function has been suggested recently. Thus, it is most important to prevent the progression of parathyroid hyperplasia in chronic renal failure by the early use of active vitamin D, calcitriol pulse therapy, and dietary phosphorus restriction.
近期的临床和实验数据表明，甲状旁腺细胞对生理浓度骨化三醇的抵抗在慢性肾衰竭继发性甲状旁腺功能亢进的发病机制及进展过程中发挥着重要作用。这种抵抗是由于甲状旁腺细胞中骨化三醇受体密度降低，这可能是由于骨化三醇受体上调受损所致。由于甲状旁腺较大的患者比腺体较小的患者对骨化三醇脉冲治疗的抵抗性更强，且骨化三醇受体密度与腺体重量呈负相关，甲状旁腺的大小可作为对骨化三醇抵抗程度的一个指标。此外，近期有人提出磷在甲状旁腺功能控制中可能发挥的作用。因此，通过早期使用活性维生素D、骨化三醇脉冲治疗及限制饮食中的磷来预防慢性肾衰竭中甲状旁腺增生的进展极为重要。
