司维拉姆对规律血液透析高磷血症患者血清炎症因子水平的影响

目的:探讨司维拉姆对规律血液透析高磷血症患者血清炎症因子水平的影响。方法:收集我院规律血液透析高磷血症患者36例,随机分为观察组和对照组,各18例。对照组给予醋酸钙片;观察组给予碳酸司维拉姆。治疗结束后,比较两组患者血磷、血钙、甲状旁腺激素(i PTH)、钙磷乘积、碳酸氢盐、低密度脂蛋白(LDL-C)及血清炎症因子超敏C反应蛋白(hs-CRP)。结果:与对照组比较,观察组治疗后血磷、钙磷乘积、LDL-C及hs-CRP水平降低(P0.05),血钙、碳酸氢盐水平升高(P0.05);观察组i PTH水平与对照组相比差异无统计学意义(P0.05)。结论:司维拉姆对规律血液透析高磷血症具有显著疗效,能降低血磷钙磷乘积、低密度脂蛋白(LDL-C)及超敏C反应蛋白(hs-CRP)水平及升高血钙、碳酸氢盐水平。(司维拉姆的一个重要作用就是不升高血钙!写反了,倒是醋酸钙可能升高血钙)     

不同血液透析方法对终末期肾病患者钙磷代谢的影响

目的：观察不同血液透析方法对终末期肾病患者钙磷代谢的影响。方法：以120例终末期肾病患者为例,比较3种透析方式：血液透析、血液透析滤过、高通量血液透析（各40例）对终末期肾病患者的钙磷代谢及甲状旁腺素的影响。结果：3组透析方法中,HFHD、HDF组治疗前后血钙、磷含量差异有统计学意义,血钙升高,血磷、甲状旁腺素得到较好的清除（P〈0．05）。结论：HFHD、HDF透析使低钙血症改善,血清磷、PTH下降显著。这说明HF,HD、HDF透析对改善钙磷代谢紊乱有积极作用,能有效预防甲旁亢。     

成纤维细胞生长因子23（FGF23)在终末期肾病患者继发性甲状旁腺功能 亢进中的作用

目的:探究成纤维细胞生长因子23(FGF23)在终末期肾病患者继发性甲状旁腺功能亢进中的作用机制。方法:选取我院2013年2月-2015年5月期间收治的58例终末期肾病进入血液透析的患者,所有患者均经甲状旁腺CT增强扫描,无增生及结节。按照i PTH值将其分为两组,i PTH300 pg/m L为观察组,150 pg/m L≤i PHT≤300 pg/m L为对照组,每组29例。患者均予碳酸钙以及活性维生素D3进行治疗。对患者钙、磷、白蛋白、血脂以及FGF23、i PTH、1,25(OH)_2D_3进行检验。结果:治疗后观察组患者FGF23及i PTH均高于对照组,差异具有统计学意义(P0.05)。观察组血尿素氮、血肌酐与透析前相比明显下降,对照组血尿素氮、血肌酐与透析前相比明显下降,差异有统计学意义(P0.01);1,25(OH)_2D_3以及血白蛋白水平是影响Log FGF23的独立影响因素。结论:FGF23在终末期肾病患者继发性甲状旁腺功能亢进发病中发生作用,可作用临床诊断依据。     

维持性血液透析患者慢性肾脏病矿物质和骨异常患病情况调查及血管钙化的危险因素分析

目的:调查维持性血液透析(MHD)患者慢性肾脏病矿物质和骨异常(CKD-MBD)患病情况,并分析血管钙化的危险因素。方法:选取2017年2月～2018年12月我院收治的MHD患者229例记为研究对象。统计并记录所有患者CKD-MBD患病情况,并通过Kauppila评分对所有患者的血管钙化情况予以评定,将患者按照Kauppila评分结果分为钙化组与非钙化组。比较两组患者基本资料以及血生化指标水平,并采用多因素Logistic回归分析MHD患者血管钙化的影响因素。结果:229例MHD患者中CKD-MBD患病率按照从高到低的顺序分别为高甲状旁腺激素(PTH)、高磷血症、低钙血症、低PTH、高钙血症、低磷血症,占比分别为45.85%、42.36%、30.57%、20.09%、19.65%、10.04%。229例MHD患者血管钙化发生率为68.56%。钙化组年龄、透析时间、血磷、颈动脉内膜中层厚度(IMT)、超敏C反应蛋白(hs-CRP)水平均高于非钙化组(均P0.05)。经多因素Logistic回归分析可得:年龄、透析时间、hs-CRP均是MHD患者血管钙化的独立危险因素(均P0.05)。结论:MHD患者CKD-MBD患病情况不容乐观,多见于高PTH、高磷血症、低钙血症。其中年龄、透析时间、hs-CRP均与MHD患者血管钙化密切相关,值得临床重点关注。     

醋酸钙联合左卡尼汀对维持性血液透析患者钙磷代谢的影响

目的：研究并评价醋酸钙联合左卡尼汀对维持性血液透析患者钙磷代谢的影响,为临床治疗提供参考依据。方法：以2013 年 8 月至2015 年2 月在我院进行维持性血液透析的50 例患者作为研究对象,按照随机法分为两组,其中对照组患者给予醋酸钙治 疗,研究组患者给予醋酸钙联合左卡尼汀治疗,比较两组患者治疗前后全段甲状旁腺素、血钙、血磷、钙磷乘积的变化。结果：与对 照组比较,研究组患者全段甲状旁腺素、血钙、血磷、钙磷乘积水平均在正常范围内,较对照组有明显改善(P<0.05);研究组全段甲 状旁腺素、血钙、血磷、钙磷乘积达标率分别为68.00%、84.00%、64.00%、80.00%,与对照组比较,血磷达标率不具有统计学差异 (P＞0.05);全段甲状旁腺素、血钙及钙磷乘积达标率差异具有统计学意义(P<0.05)。结论：醋酸钙联合左卡尼汀对维持性血液透析 患者甲状旁腺素、钙磷代谢的改善效果较单用醋酸钙更佳。     

血液透析与腹膜透析对终末期糖尿病肾病患者预后的影响

目的:对比分析血液透析与腹膜透析对终末期糖尿病肾病患者预后情况的影响。方法:选择2011年1月~2016年10月在我院进行诊治的终末期糖尿病肾病患者100例,随机分为血液透析组以及腹膜透组,每组各50例。分别给予血液透析治疗以及腹膜透治疗,比较两组患者透析前后的舒张压、收缩压、血红蛋白、血白蛋白、血磷、免疫反应性甲状旁腺激素以及血钙水平,观察患者的2年生存情况、3年生存情况以及死亡原因。结果:两组透析前后的舒张压、收缩压、血红蛋白、血磷、免疫反应性甲状旁腺激素以及血钙水平相比均无明显差异(P0.05),且两组间相比无明显差异(P0.05),血液透析组透析后的血白蛋白水平明显高于透析前(P0.05),且血液透析组透析后的血白蛋白水平明显高于腹膜透析组(P0.05);血液透析组存活2年者33例,存活3年者26例;腹膜透析组存活2年者32例,存活3年者25例。两组患者之间相比无明显差异(P0.05)。两组患者的死亡原因主要包括包括多器官功能衰竭、心力衰竭、脑出血、重度感染以及休克等。结论:血液透析以及腹膜透析均为治疗终末期糖尿病肾病的有效方法,且二者对终末期糖尿病肾病患者预后情况的影响无明显差异,可根据患者的具体情况选用合适的透析治疗方法。     

醛固酮在终末期肾病患者动脉血管钙化中作用的研究进展

动脉血管钙化是终末期肾病(ESRD)患者发生心血管事件的重要原因。升高的血钙、血磷、1,25-(OH)2-维生素D3、炎症与氧化应激等因素共同促进了ESRD患者血管钙化的发生。最近发现,醛固酮可通过诱发血管局部炎症、增加氧化应激水平、分泌骨化相关蛋白、促进血管平滑肌细胞凋亡等多种机制诱导ESRD患者发生血管钙化。积极干预醛固酮的有害效应,对于早期防治ESRD患者血管钙化可能有重要意义。     

碳酸镧咀嚼片联合依降钙素对血液透析高磷血症患者冠状动脉钙化及血磷水平的影响

摘要 目的：观察碳酸镧咀嚼片联合依降钙素对血液透析高磷血症患者冠状动脉钙化及血磷水平的影响。方法：选取2019年8月~2021年3月我院接收的血液透析高磷血症患者120例,采用双色球法,将患者分为对照组（60例,依降钙素治疗）和观察组（60例,在对照组基础上结合碳酸镧咀嚼片治疗）,对比两组疗效、血磷、血钙、钙磷乘积、全段甲状旁腺激素（iPTH）、成纤维生长因子23（FGF-23）、冠状动脉钙化积分（CACS）,观察两组不良反应发生情况。结果：观察组临床总有效率（91.67%）优于对照组（70.00%）（P<0.05）。两组不良反应发生率组间对比无差异（P>0.05）。观察组治疗结束后血磷、iPTH、血钙、FGF-23、钙磷乘积、CACS低于对照组（P<0.05）。结论：血液透析高磷血症患者采用碳酸镧咀嚼片联合依降钙素治疗,可延缓冠状动脉钙化,有效降低血磷水平,安全有效。     

高通量血液透析联合肾衰宁颗粒对尿毒症患者钙磷代谢、炎症反应以及营养状况的影响

摘要 目的：探讨高通量血液透析（HFHD）联合肾衰宁颗粒对尿毒症患者钙磷代谢、炎症反应以及营养状况的影响。方法：选取2017年1月~2019年10月在我院接受血液透析治疗的尿毒症患者114例作为研究对象,按随机数字表法分成对照组和观察组,每组各57例,对照组给予HFHD,观察组在对照组基础上口服肾衰宁颗粒。两组均治疗3个月。比较两组患者治疗前后肾功能指标,包括尿素氮（BUN）、血肌酐（Scr）、肾小球滤过率（GFR）;钙磷代谢相关指标血清钙、血清磷、甲状旁腺激素（PTH）;炎症反应指标,包括降钙素原（PCT）、C反应蛋白（CRP）、白细胞介素-6（IL-6）;营养状况指标,包括白蛋白（ALB）、血红蛋白（Hb）、血清总蛋白（TP）。结果：治疗后两组患者BUN、Scr、GFR、血清磷、PTH、PCT、CRP、IL-6较治疗前降低,血清钙、ALB、Hb、TP较治疗前升高,观察组患者BUN、Scr、GFR、血清磷、PTH、PCT、CRP、IL-6低于对照组,血清钙、ALB、Hb、TP高于对照组,差异均有统计学意义（P<0.05）。结论：HFHD联合肾衰宁颗粒治疗尿毒症,可有效改善患者的钙磷代谢和肾功能,改善机体炎症状态及营养状况。     

不同病理类型的原发性甲状旁腺功能亢进临床特征及生化指标的相关性分析

摘要 目的：分析不同病理类型的良性原发性甲状旁腺功能亢进（primary hyperparathyroidism,PHPT）患者临床特征和术前术后生化指标变化的不同,探讨其相关性,为该病的诊断与治疗提供思路。方法：收集行手术治疗的良性PHPT患者56 例,回顾性分析其临床资料及术前术后生化指标的变化,并按术后病理结果对其进行分组,比较其临床特征及生化指标的差异。结果：按病理类型将患者分为4组：甲状旁腺腺瘤（PA组）21 例（37.5%）,甲状旁腺腺瘤样增生（PAH组）28 例（50.0%）,甲状旁腺非典型腺瘤样增生（PAAH组）5例（8.93%）,甲状旁腺腺瘤合并甲状旁腺腺瘤样增生（PA+PAH组）2例（3.57%）。PHPT患者中女性明显高发,男女比例为1：5.22,且在PAH组所占比重明显高于PA组（P>0.05）。各组临床表现无明显差异。术前PTH在PAAH组明显高于PAH组,而术前血钙、血磷、25-羟基维生素D3在各组间比较无显著性差异。多处病灶有66.67%发生在PAH组,组间比较有显著性差异（x²=20.160a, P=0.000）。术后病理标本最大直径在PA组明显大于PAH组（P<0.05）,而在其余各组间比较无统计学差异（P>0.05）。PTH在术中标本切除后数值迅速下降,在术后第一天略有上升;血钙在术后呈持续下降趋势。PTH及血钙的下降幅度在各组间比较无显著性差异（P>0.05）。结论：良性原发性甲状旁腺功能亢进症中老年女性高发,尤其在PAH组明显高发。各种病理类型临床表现无差异。多处病灶主要集中在PAH组,PA组术后病理标本最大直径最大,PAAH组术前PTH水平最高,应对PAAH组患者加强术后PTH随访。     

Renal clearance of phosphate and calcium in vitamin D-deficient chicks: effect of calcium loading, parathyroidectomy, and parathyroid hormone administration.

Serum and renal clearance values of phosphate and calcium were measured and compared in 4 week-old vitamin D-deficient and vitamin D-replete chickens (Gallus gallus). D-deficient chicks had significantly lower body weights and serum calcium values; however, their renal functions were not different from D-replete controls. Serum calcium values in D-deficient birds did not change in response to parathyroid hormone (PTH) administration; however, they did drop significantly in response to parathyroidectomy (PTX). Serum phosphate values of D-deficient birds, but not D-replete birds, rose significantly after PTX. Clearance of phosphate is known to increase after administration of PTH. This conspicuous effect was absent in PTH-injected vitamin D-deficient chickens. PTX caused the excretion of phosphate to drop in both D-deficient and D-replete birds to near zero. Conversely, PTX of both D-deficient and D-replete chickens stimulated the excretion of more calcium than in controls. Calcium loading elevates the fractional excretion of calcium in both D-deficient and D-replete birds. It also causes a decrease in phosphate excretion in both groups, presumably by inhibiting the secretion of PTH. PTH administration to D-replete, calcium-loaded birds caused increased phosphate excretion (as it did in normal controls), an effect that was not seen in similarly treated D-deficient birds. Therefore, most renal functions studied after calcium loading, PTH administration, or PTX are not altered by vitamin D deficiency in the chicken. The major significant finding is that vitamin D-deficient chickens do not excrete increased amounts of phosphate in response to PTH stimulus.     

终末期肾脏病患者睡眠质量的影响因素及其与生活质量、焦虑抑郁的关系研究

目的:探讨终末期肾脏病(ESRD)患者睡眠质量的影响因素及其与生活质量、焦虑抑郁的关系.方法:选取2018年3月～2019年12月期间我院收治的ESRD患者198例为研究对象.患者睡眠质量采用匹兹堡睡眠指数量表(PSQI)评价.采用焦虑自评量表(SAS)与抑郁自评量表(SDS)评估患者焦虑、抑郁状态.采用肾病生活质量评...     

The Effect of Bovine Parathyroid Hormone Withdrawal on MC3T3-E1 Cell Proliferation and Phosphorus Metabolism

Hypocalcemia and hypophosphatemia are common complications after parathyroidectomy (PTX). Sudden removal of high circulating levels of parathyroid hormone (PTH) causes decreased osteoclastic resorption resulting in a decreased bone remodeling space. These phenomena are likely due to an increased influx of calcium and phosphorus into bone. However, there are currently no data to support this hypothesis. In this study, we found that PTX significantly reduced levels of PTH, calcium and phosphate. Compared with preoperative levels, after 1 year, postoperative PTH, calcium and phosphate levels were 295.6 ± 173.7 pg/mL (P < 0.05), 86.62 ± 15.98 mg/dL (P < 0.05) and 5.56 ± 2.03 mg/dL (P < 0.05), respectively. We investigated continuous bovine PTH administration as well as withdrawal of bovine PTH stimulation in the mouse osteoblast precursor cell line MC3T3-E1. MC3T3-E1 cells were cultured with continuous bovine PTH treatment for 20 days or with transient bovine PTH treatment for 10 days. High doses of continuous bovine PTH exposure strongly reduced cell proliferation, alkaline phosphatase activity and the number of mineralized calcium nodules. However, withdrawal of bovine PTH (100 ng/mL) significantly increased the number of mineralized calcium nodules and caused a rapid decline in calcium and phosphorus content of culture medium. In conclusion, continuous exposure to bovine PTH inhibited osteoblast differentiation and reduced the formation of mineralized nodules. However, this inhibition was removed and mineralized nodule formation resumed with withdrawal of bovine PTH. According to the results of our clinical examinations and in vitro experiments, we hypothesize that the sudden removal of high levels of PTH may cause an increased influx of calcium and phosphorus into bone after PTX.     

High phosphorus diet changes phosphorus metabolism regardless of PTH action in rats

In this study, we ascertained whether the parathyroid hormone (PTH) dominantly regulated the effects of high phosphorus (P) intakes on urinary excretion of P and bone metabolism in rats. To maintain serum PTH level equally, parathyroidectomy (PTX) and sham-operated rats were constantly exposed to rPTH(1-34) and fed both control (0.3% P) and high P (1.2% P) diet for 7 days, respectively. Urinary excretions of P and C-terminal telopeptides of type I collagen were significantly increased in both PTX and sham rats by the high P diet. These results suggest that high P diet increased urinary P excretion while promoting bone resorption regardless of PTH-dependent regulation.     

Association between parathyroid hormone (PTH)/PTH-related peptide receptor gene polymorphism and the extent of bone mass reduction in primary hyperparathyroidism.

Genetic contributions to bone mineral density (BMD) and bone turnover are well known. In the present study, we analyzed the relationship between polymorphism of parathyroid hormone (PTH)/PTH-related peptide (PTHrP) receptor gene existing in exon M7 and the clinical characteristics of primary hyperparathyroidism (pHPT). PTH/PTHrP receptor genotypes were analyzed in 92 pHPT patients by direct sequence to determine whether nucleotide 1417 of the cDNA was C or T. BMD levels at the lumbar spine and at the radius before and one year after parathyroidectomy, as well as serum levels of calcium, phosphorus, alkaline phosphatase (ALP) and intact PTH were measured. Although there were no significant differences in serum levels of calcium, phosphorus and intact PTH, ALP was significantly lower in the CT genotype compared with the TT genotype. BMD level at the radius was significantly higher in the CT genotype than in the CC genotype. Moreover, an increase in radial BMD one year after parathyroidectomy was significantly less in CT genotype than two other genotypes (CC, TT). The present study is the first to indicate that the polymorphism of PTH/PTHrP receptor gene is closely related to the extent of bone mass reduction in pHPT and that this polymorphism would be one of the genetic factors responsible for the severity of the pathological state of pHPT.     

Somatostatin analogues do not affect calcium metabolism in patients with acromegaly and primary hyperparathyroidism [corrected] due to MEN 1-like syndrome

Patients with clinical features of MEN 1 without mutations in the menin gene fulfill the criteria of MEN1-like syndrome. Primary hyperparathyroidism (PHP) is the most frequent clinical finding in both syndromes and is usually treated by surgery. However, PHP has been reported to respond to somatostatin analogues (SSA) in MEN 1 patients. 7 patients with PHP in the context of MEN 1-like syndrome (and absence of mutations in the menin gene) were enrolled in the study and treated with SSA for 6 months for the non-PHP disease before parathyroidectomy. Serum ionized calcium, phosphorus, and PTH concentrations, and 24-h urinary calcium and phosphorus excretion were measured before and after SSA therapy. Mean serum ionized calcium, phosphorus, and PTH concentrations did not significantly change after a 6-month course with SSA. SSA scintigraphy did not reveal uptake in the neck region corresponding to the parathyroid adenoma identified at surgery and confirmed at histology. However, immunohistochemistry revealed SS-type 2A receptor in parathyroid tissue samples of 6 out of 7 patients. SSA therapy does not affect calcium-phosphorus metabolism in patients with MEN 1-like syndrome, suggesting that the drug has no role in controlling PHP in these subset of patients.     

Increase of nocturnal melatonin levels in hemodialyzed patients after parathyroidectomy: a pilot study

In hemodialyzed patients hormonal disturbances are known to occur. However, melatonin levels have not been completely studied. The aim of the study was to find whether changes in calcaemia affect melatonin secretion. For this reason we followed the nocturnal serum concentrations of melatonin and parathyroid hormone (PTH) in 9 hemodialyzed patients (6 women and 3 men, aged 37-65 years) both before and 1-3 months after parathyroidectomy at 6 p.m., 9 p.m., 11 p.m., 2 a.m., 5 a.m. and 7 a.m. At 6 p.m. blood samples to evaluate the levels of calcium and phosphate were also collected. Parathyroidectomy resulted in an increase in nocturnal melatonin levels. As expected, the parathyroidectomy was followed by considerable PTH decrease. PTH showed no nocturnal variation before or after parathyroidectomy. Calcium levels significantly decreased after the operation while phosphate levels increased. In summary, in hemodialyzed patients with hyperparathyroidism, parathyroidectomy significantly increases the nocturnal secretion of melatonin. Relationships between the pineal gland and parathyroid glands have yet to be elucidated.     

Unusual Case of Calciphylaxis Associated with Primary Hyperparathyroidism Without Coexistent Renal Failure

ObjectiveTo report a case of calciphylaxis in a patient with primary hyperparathyroidism without coexistent renal failure.MethodsThe clinical, laboratory, and radiographic details of this case are reviewed, and the pathogenesis of calciphylaxis and the associated prognosis are discussed.ResultsA 52-year-old woman had progressive fatigue, cachexia, severe osteoporosis, and necrotizing skin lesions. Her serum calcium level was 16 mg/dL, serum phosphorus level was 2.13 mg/dL, and parathyroid hormone level was 2,257 pg/mL (reference range, 15 to 65). On physical examination, gangrenous skin lesions with black crusts were noted on her legs, abdomen, and gluteal region. A mass lesion was detected in the parathyroid region by both ultrasonography and a parathyroid scan. The patient underwent a bilateral neck exploration, and a parathyroid adenoma measuring 3.5 by 1.5 by 1.2 cm was found on pathologic examination. After the operation, biochemical findings normalized, and the skin lesions progressively improved.ConclusionSevere primary hyperparathyroidism may be a factor leading to calciphylaxis, even in the absence of renal failure and a high calcium-phosphate product. This potentially life-threatening condition should not be left untreated if the levels of serum calcium and parathyroid hormone are severely elevated. (Endocr Pract. 2008;14:368-372)