大剂量1,25(OH)_2D_3口服冲击治疗血透患者甲状旁腺素和血小板胞内游离钙异常

THE EFFECT OF ORAL 1,25(OH) 2D 3 PULSE THERAPY ON PTH AND PLATELET CYTOSOLIC FREE CALCIUM ABNORMALITIES IN HEMODIALYSIS PATIENTS

目的：了解大剂量１，２５（ＯＨ）２Ｄ３口服冲击对血透患者血清甲状旁腺素［ＰＴＨ（１～８４）］和血小板胞内游离钙浓度（Ｐｔ［Ｃａ２＋］ｉ）的影响和相互关系。方法：用Ｆｕｒａ２荧光测定法和免疫放射法对１２例血透患者测定Ｐｔ［Ｃａ２＋］ｉ和ＰＴＨ（１～８４）。结果：静息Ｐｔ［Ｃａ２＋］ｉ和ＰＴＨ（１～８４），治疗前是升高的，治疗后则降低；且两者密切相关，其Ｐ值治疗前＜０００１，治疗后＜００２５。多因素逐步回归显示：ＰＴＨ（１～８４）在Ｐｔ［Ｃａ２＋］ｉ的影响中起显著作用。结论：大剂量１，２５（ＯＨ）２Ｄ３冲击治疗能降低Ｐｔ［Ｃａ２＋］ｉ和ＰＴＨ（１～８４）。

OBJECTIVE To study the effect of oral 1,25(OH) 2 D 3 pulse therapy on PTH and platelet cytosolic free calcium {Pt[Ca 2+ ] i } abnormalities in hemodialysis patients. METHODOLOGY Twelve maintained hemodialyzed(MHD) patients were included and 10 healthy volunteer as the control. 1,25(OH) 2 D 3 (Rectrol) was administed to MHD patients orally at 8 μg/week in two divided dose for eight weeks. Pre dialysis blood were sampled at the 0, 4, 8th week of the treatment. Fura 2 fluorometry and immunoradioassy were used to detect PTH(1 84) and Pt[Ca 2+ ] i. RESULTS Resting PTH(1 84)(25.87±15.98 nmol/L) and Pt[Ca 2+ ] i (186.47±80.34 nmol/L) were found significantly increased before treatment( P <0.001) as compared to the normal control(4.13±1.99,103.76±54.91nmol/L). Resting PTH(1 84) and Pt[Ca 2+ ] i decreased significanlty at the 4th week of the treatment( P <0.05) and restored to normal range at the 8th week of the treatment. Multiple stepwise regression analysis showed that PTH(1 84) is the most important factor affecting Pt[Ca 2+ ] i level. CONCLUSION Oral 1,25(OH) 2 D 3 pulse therapy can restore Pt[Ca 2+ ] i and PTH(1 84) level to normal range in eight weeks.