Fujisaki T, Hida M, Hiraga S, Osamura R Y
Department of Transplantation, Tokai University School of Medicine, Isehara, Japan.
Nephron. 1997;77(1):68-75. doi: 10.1159/000190249.
Secondary hyperparathyroidism is one of the severe complications of chronic renal failure. In this study, we investigated the cellular components of parathyroid tissue, with measurements of various serum parathyroid hormone (PTH) types in the circulation, and evaluated their clinical significance in hemodialysis patients. Thirty-eight patients who underwent both subtotal parathyroidectomy and autotransplantation in Tokai University Hospital from 1979 to 1994 were divided into two groups. Group 1 (G-1) was not administered active-type vitamin D3 (VD; 19 patients; 15 males and 4 females), and group 2 (G-2) was administered VD (19 patients; 10 males and 9 females). The parathyroid tissues which were obtained from G-1 and G-2 patients were classified into three classes based on the size of the oxyphilic cell area (class I < 25%, class II 25-50% and class III > 50%). Our results showed that the proliferation index of parathyroid tissues in the oxyphilic cell area was higher in G-2 than that in G-1. Immunohistochemically, MIB-1 staining was more intense than that in the chief cell area in G-2 patients. Moreover, the proliferative index in the same specimen was also higher in the oxyphilic cell area than in the chief cell area. It was suggested that the oxyphilic cells proliferated independently. Furthermore, synthesis of PTH in the oxyphilic cell area was revealed immunohistochemically by the presence of PTH and was confirmed by positive staining of PTH mRNA in the oxyphilic cell area with in situ hybridization. HS(M-terminal)- and C-PTH levels in the serum were significantly higher in class III than in class I (p < 0.01). No significant difference of HS- and C-PTH levels between class II and class III was noted. Moreover, no significant difference of intact-PTH levels was found in all three classes. From the above findings, it was suggested that proliferation of the parathyroid tissues or secretory state of PTH in hemodialysis-maintained patients with secondary hyperparathyroidism, which was closely related to the proliferation of oxyphilic cells, can be more accurately reflected by HS- and C-PTH levels than by the intact-PTH level. Therefore, it was suggested that HS- and C-PTH levels in the serum are important indices for accurate evaluation of the pathology and suitable therapy of secondary hyperparathyroidism, as well as observation of the clinical course.
继发性甲状旁腺功能亢进是慢性肾衰竭的严重并发症之一。在本研究中，我们调查了甲状旁腺组织的细胞成分，并检测了循环中各种血清甲状旁腺激素（PTH）类型，评估了它们在血液透析患者中的临床意义。1979年至1994年在东海大学医院接受甲状旁腺次全切除术和自体移植的38例患者被分为两组。第1组（G-1）未给予活性型维生素D3（VD；19例患者，15例男性和4例女性），第2组（G-2）给予VD（19例患者，10例男性和9例女性）。根据嗜酸性细胞区域的大小，将从G-1和G-2患者获得的甲状旁腺组织分为三类（I类<25%，II类25-50%，III类>50%）。我们的结果显示，G-2组甲状旁腺组织嗜酸性细胞区域的增殖指数高于G-1组。免疫组织化学显示，G-2组患者MIB-1染色在主细胞区域比在嗜酸性细胞区域更强烈。此外，同一标本中嗜酸性细胞区域的增殖指数也高于主细胞区域。提示嗜酸性细胞独立增殖。此外，免疫组织化学显示嗜酸性细胞区域存在PTH，原位杂交显示嗜酸性细胞区域PTH mRNA呈阳性染色，证实嗜酸性细胞区域可合成PTH。III类患者血清中HS（M端）-PTH和C-PTH水平显著高于I类（p<0.01）。II类和III类患者的HS-PTH和C-PTH水平无显著差异。此外，所有三类患者的完整PTH水平均无显著差异。从上述结果提示，维持血液透析的继发性甲状旁腺功能亢进患者甲状旁腺组织的增殖或PTH的分泌状态与嗜酸性细胞的增殖密切相关，HS-PTH和C-PTH水平比完整PTH水平能更准确地反映这一情况。因此，血清中HS-PTH和C-PTH水平是准确评估继发性甲状旁腺功能亢进的病理和合适治疗以及观察临床病程的重要指标。
