全段甲状旁腺激素在继发性甲旁亢早期诊断中的意义

The Clinical Significance of Serum Intact PTH Measurement by Two-site Immunoradiometric Assay in the Early Diagnosis of Secondary Hyperparathyroidism

目的：探讨双位点免疫放射分析法（IRMA）检测血清全段甲状旁腺激素（intactPTH）在慢性肾衰继发性甲状旁腺机能亢进（SHPT）早期诊断中的意义。方法：采用德普公司生产的intactPTHIRMA药盒，检测118例慢性肾衰患者和67例健康人血清intactPTH和其它血生化指标，观察其中24例慢性肾衰患者髂骨活检不脱钙切片的病理学改变，并进行督组织形态计量学参数测量。结果：慢性肾衰早期钙磷代谢尚无明显异常时，血清intactPTH水平已升高，且与骨活检病理学改变一致，血清mintactPTH浓度与反映骨吸收、骨转换活跃程度的计量学参数骨吸收表面的百分率（TRS／TBS）呈正相关。结论：双位点IRMA测定血清intactPTH水平可用于早期诊断慢性肾衰继发性甲状旁腺机能亢进。

Objective:To study the clinical significance of serum intact PTH measurement by two-site immunoradiometric assay in the early diagnosis of secondary hyperparathyroidism patients with chronic renal failure(CRF).Methods:The serum intact PIH concentration of 118 inpatients with chronic renal failure and 67 healthy subjects was measured by the Coat-A-Count intact PTH immunoradiometric assay(IRMA)kit produced by DPC,USA.Other serum biochemical indices including serum ereatinine,calcium and phosphate,were also examinated.Transiliac crest bone biopsy had been performed on the 24 volunteers of the inpatients mentioned above and pathological changes were observed on undecalicfied bone biopsy specimens.The parameters of bone histomorphometry were quantitated from these specimens by means of a semiautomated digitizing system.Resulte：The serum intact PTH level in the patients with CRF was markedly higher that that in the healthy persons ,and rising of serum intact PTH level existed even when there was no marked abnormality 9n serum calium and phosphate,while there were distinct pathological changes in bone specimens.A good relationship existed between serum intact PTH concentration and the parameter TRS/TBS which reflects bone resorption and turnover.Conclusion:The concentration of serum intact PTH measured by two-sit IRMA can truly reflect the parathyroid secretion and can serve as a good predictor for early diagnosis of secondary hyperparathyroidism patients with chronic renal failure.