Combe C, de Précigout V, Lasseur C, Lafage M H, Blanchetier V, Aparicio M
Service de néphrologie, Hôpital Pellegrin, Bordeaux.
Nephrologie. 1996;17(3):149-56.
Secondary hyperparathyroidism (HPT II) occurs early in the course of chronic renal failure (CRF), mainly because of decreased calcitriol levels, low levels of serum calcium, retention of phosphorus, abnormal parathyroid gland function and hyperplasia, and peripheral resistance to the action of parathormone (PTH). Amongst these factors, phosphorus retention plays a crucial role in moderate and advanced CRF, by inhibiting renal calcitriol synthesis, lowering serum calcium levels and stimulating PTH secretion. In patients with mild CRF, phosphorus restriction prevents the development of HPT II by increasing renal calcitriol secretion. In patients with advanced CRF, the suppressive effect of phosphorus restriction may be obtained independent of any changes in plasma calcitriol levels, suggesting a direct effect of phosphorus on parathyroid function. Phosphorus restriction should be used in the early stages of CRF, together with a sufficient intake of calcium in the form of phosphorus chelating salts. When phosphorus and calcium serum concentrations are normalised but PTH levels are not in the target range, 1 alpha hydroxy vitamin D3 derivatives may be used, with a careful monitoring to avoid high serum levels of phosphorus or calcium.
继发性甲状旁腺功能亢进（HPT II）在慢性肾衰竭（CRF）病程早期就会出现，主要原因是骨化三醇水平降低、血清钙水平低、磷潴留、甲状旁腺功能异常及增生，以及对甲状旁腺激素（PTH）作用的外周抵抗。在这些因素中，磷潴留通过抑制肾脏骨化三醇合成、降低血清钙水平和刺激PTH分泌，在中晚期CRF中起关键作用。在轻度CRF患者中，限制磷摄入可通过增加肾脏骨化三醇分泌来预防HPT II的发生。在晚期CRF患者中，限制磷摄入的抑制作用可能与血浆骨化三醇水平的任何变化无关，这表明磷对甲状旁腺功能有直接影响。在CRF早期应采用限制磷摄入，同时以磷螯合盐的形式充分摄入钙。当血清磷和钙浓度恢复正常但PTH水平不在目标范围内时，可使用1α-羟维生素D3衍生物，并仔细监测以避免血清磷或钙水平过高。
