钙剂摄入不足和(或)维生素D缺乏/不足相关甲状旁腺功能增强和亢进症的转归与防治

Prevention and treatment of calcium and/or vitamin D insufficiency associated parathyroid hyperfunction and hyperparathyroidism

甲状旁腺功能亢进症(甲旁亢)是严重影响人类健康的常见内分泌系统疾病,据其病因不同,可分为原发性、继发性和三发性。临床中发现一些原发性甲旁亢可能是源于钙摄入不足和(或)维生素D缺乏/不足所致的继发性和三发性甲旁亢,并成为临床中常见的甲旁亢类型。我国人群每日钙摄入量普遍不足,维生素D可促进钙的吸收,但维生素D缺乏/不足是世界性公共健康问题。长期相对低血钙水平将刺激甲状旁腺增生,分泌过量的甲状旁腺素,引起甲状旁腺功能增强(甲旁亢前期)并可逐渐演变为继发性甲旁亢,破坏骨质释放骨钙入血,致全身多器官组织病变。通过钙镁磷、甲状旁腺素、维生素D等骨代谢指标和甲状旁腺超声的筛查可早期发现甲旁亢前期和甲旁亢,早期予以钙剂和维生素D的补充可控制疾病的发展,变"不可防、不可控"为"可防可控"。倡导骨代谢指标和甲状旁腺超声的健康筛查,加强钙剂摄入不足和(或)维生素D缺乏/不足相关甲状旁腺功能增强和亢进症的防治,人群中骨健康状况、泌尿系结石、转移性血管钙化及全身钙质异常迁徙沉淀等病变将得到明显改善。

Hyperparathyroidism is a common endocrine disease that seriously affects human health,depending on its etiology,which can be divided into three types:primary,secondary and tertiary.In clinical practice,we found that some primary hyperparathyroidism may be secondary or tertiary hyperparathyroidism caused by insufficient calcium intake and/or vitamin D deficiency/insufficiency,and become a common type of hyperparathyroidism.The daily calcium intake of Chinese people is generally insufficient.Vitamin D can promote the absorption of calcium,but vitamin D deficiency/insufficiency is also a worldwide public health problem.Long-term hypocalcemia will stimulate parathyroid hyperplasia and secrete excessive parathyroid hormone,resulting in parathyroid hyperfunction(pre-hyperparathyroidism)and then secondary hyperparathyroidism,both of which may damage bone and release calcium into blood,leading to diseases of multiple organs and tissues.The detection of bone metabolism indexes such as calcium,magnesium,phosphorus,parathyroid hormone and vitamin D may be helpful for the early diagnosis of pre-hyperparathyroidism and hyperparathyroidism.Supplementation of calcium and vitamin D in early stage can control the development of the disease and change"unpreventable and uncontrollable"into"preventable and controllable".The health screening of bone metabolism indexes and parathyroid ultrasonography should be advocated,and the prevention and treatment of calcium and/or vitamin D insufficiency associated parathyroid hyperfunction and hyperparathyroidism should be strengthened,so as to greatly improve the bone health,urinary calculus,metastatic vascular calcification and systemic abnormal calcium migration and precipitation in the population.