Kosowicz J, Baszko-Błaszyk D, Horst-Sikorska W, Ruszkowska J
Klinika Endokrynologii Akademii Medycznej w Poznaniu.
Pol Arch Med Wewn. 1998 Apr;99(4):287-97.
Hyperparathyroidism, both primary and secondary in chronic renal failure, leads to pathologic changes in the bones. Newly introduced markers of bone metabolism enable to biochemically detect and evaluate these changes. The aim of our studies was to perform determinations of serum osteocalcin as a marker of bone formation, and C-terminal telopeptide of collagen I (ICTP) as a marker of bone resorption in patients with excessive secretion of parathyroid hormone (PTH). Our studies comprised of 15 patients with primary and 24 patients with secondary hyperparathydroidism. In all patients serum PTH, osteocalcin and ICTP were detected by radioimmunoassay; the correlations between PTH and osteocalcin as well as between PTH and ICTP were also performed. Serum PTH was elevated in both, primary and secondary hyperparathyroidism. In primary hyperparathyroidism serum osteocalcin was moderately or definitely elevated, similarly serum ICTP was high. Following surgical removal of a parathyroid adenoma, concomitantly with a drop in serum PTH there was a rapid normalization of serum osteocalcin and ICTP. Secondary hyperparathyroidism in uraemia was characterised by markedly elevated serum osteocalcin and ICTP which surpassed the concentration of these markers in primary hyperparathyroidism. There was a positive correlation between serum PTH and osteocalcin levels, and a lower correlation between PTH and ICTP. From our studies it is concluded that excessive secretion of PTH in primary and secondary hyperparathyroidism stimulates bone formation and to higher degree--bone resorption.
甲状旁腺功能亢进，包括慢性肾衰竭中的原发性和继发性，都会导致骨骼发生病理变化。新引入的骨代谢标志物能够从生化角度检测和评估这些变化。我们研究的目的是测定血清骨钙素作为骨形成的标志物，以及I型胶原C末端肽（ICTP）作为甲状旁腺激素（PTH）分泌过多患者骨吸收的标志物。我们的研究包括15例原发性甲状旁腺功能亢进患者和24例继发性甲状旁腺功能亢进患者。对所有患者均采用放射免疫分析法检测血清PTH、骨钙素和ICTP；同时还分析了PTH与骨钙素以及PTH与ICTP之间的相关性。原发性和继发性甲状旁腺功能亢进患者的血清PTH均升高。在原发性甲状旁腺功能亢进中，血清骨钙素中度或明显升高，血清ICTP同样升高。手术切除甲状旁腺腺瘤后，随着血清PTH下降，血清骨钙素和ICTP迅速恢复正常。尿毒症患者的继发性甲状旁腺功能亢进表现为血清骨钙素和ICTP显著升高，超过原发性甲状旁腺功能亢进中这些标志物的浓度。血清PTH与骨钙素水平呈正相关，而PTH与ICTP之间的相关性较低。从我们的研究得出结论，原发性和继发性甲状旁腺功能亢进中PTH的过度分泌刺激骨形成，且在更大程度上刺激骨吸收。
