肾性甲状旁腺功能亢进症的进展

Progress on renal hyperparathyroidism

肾性甲状旁腺功能亢进症(renal hyperparathyroidism,rHPT)是在慢性肾脏病(chronic kidney disease,CKD)钙磷代谢紊乱和维生素D作用减退进行性加重基础上的人体适应性反应,其特征是甲状旁腺增生和甲状旁腺素(parathyroid hormone,PTH)过度合成和分泌。它在肾功能衰竭早期开始出现,与骨折、心血管疾病和死亡风险增加有关。在慢性肾脏疾病早期可通过补充维生素D和减少磷摄入来治疗,在疾病发展后期可使用拟钙剂进行治疗,对药物治疗欠佳的难治性继发性甲状旁腺功能亢进症(secondary hyperparathyroidism,SHPT)可行甲状旁腺切除术,肾移植也可改善rHPT,但不能治愈。本综述总结了rHPT的病理生理学、诊断和药物治疗方案,阐述肾移植的疗效,并对甲状旁腺切除术治疗SHPT的适应证和策略进行探讨。

Renal hyperparathyroidism(rHPT)is an adaptive response of human body based on the disorder of calcium and phosphorus metabolism in chronic kidney disease(CKD)and the progressive aggravation of vitamin D hypofunction,characterized by hyperparathyroidism and excessive synthesis and secretion of parathyroid hormone(PTH).It occurs in the early stage of renal failure and is associated with increased risk of fracture,cardiovascular disease and death.The vitamin D supplementation and reduction of phosphorus intake can be used in the early stage of CKD,while calcium mimetic agent can be used in the end-stage of CKD.For the refractory secondary hyperparathyroidism(SHPT)with poor drug treatment,parathyroidectomy can be performed.Renal transplantation can improve rHPT,but can’t cure that.In this review,we summarized the pathophysiology,diagnosis and drug treatment of rHPT,elaborated the effect of renal transplantation,and discussed the indication and strategy on SHPT.