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继发性甲状旁腺功能亢进致软组织及动脉血管严重转移性钙化1例
1 临床资料患者男性,56岁,维持性血液透析12年,双下肢发凉发麻疼痛2月于2009年9月9日入院.患者1997年因慢性肾衰竭尿毒症期、慢性肾小球肾炎,开始血液透析,每周2次,每次4h,至2000年开始每周3次,长期未检验全段甲状旁腺素(intact parathyroid hormone,iPTH)及血钙、磷等,未给予碳酸钙和骨化三醇治疗.2003年于左腕部沿桡动脉走行触及2包块,边缘不规则,质硬,大包块直径4~5 cm,小包块直径3 cm,同时于左腋下触及直径2 cm左右圆形包块,颈后直径4 cm圆形包块,两者活动度好、质韧,与皮肤不粘连,包块进行性长大,2005年于当地医院部分切除左腕较大的包块,病理为干酪样钙化物.
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沿Blaschko线分布的特发性皮肤钙沉着症
患者女,54岁.左侧胸背部条带状硬化性结节、斑块32年就诊.皮肤科检查:左胸背部可见沿Blaschko线分布的近肤色的硬性斑块,其上散布着小指头至黄豆大小淡白色硬性结节,移动性差,病变区域皮肤硬化萎缩.胸背部皮损未过中线.实验室检查:血清钙、磷水平正常,碱性磷酸酶、甲状旁腺素正常.皮损组织病理检查:组织为纤维瘢痕,伴片状钙化.诊断:沿Blaschko线分布的特发性皮肤钙沉着症.
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维持性血液透析患者钙磷代谢紊乱治疗进展
钙磷代谢紊乱是行维持性血液透析(maintenance hemo-dialysis,MHD)治疗的终末期肾病(end-stage renal disease, ESRD)患者严重的临床并发症之一。长期的钙磷代谢紊乱可引发残余肾功能进一步丢失,导致继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)、骨和矿物质代谢异常、软组织和血管转移性钙化等,这些病理生理改变可引起明显的皮肤瘙痒、骨痛、骨质疏松等临床症状,甚至影响患者的生活质量,增加病死率。有效控制血钙、血磷、全段甲状旁腺素(intact parathyroid hormone,iPTH )水平是降低MHD 患者各种临床并发症、改善预后的关键。目前,纠正钙磷代谢紊乱的主要治疗措施包括饮食限磷、使用磷结合剂及血液净化治疗等,但不良反应较多。随着非铝、非钙新型磷结合剂的使用,无疑又使治疗跨越了一大步,本文综述MHD 患者钙磷代谢紊乱的治疗进展。
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维持性血液透析患者钙磷代谢现状分析
2004年美国肾脏数据系统曾报告约50%的血液透析患者死于心血管系统疾病[1].透析预后与实践研究(dialysis outcomes and practice patterns study,DOPPS)显示仅有8%的患者血清钙、磷和钙磷乘积以及全段甲状旁腺素(intact parathyroid hormone,iPTH)达到目标值[2],提示目前钙磷代谢紊乱及甲状旁腺功能亢进仍然是维持性血液透析(maintenance hemodialysis,MHD)患者普遍存在的问题.为了解我院血液透析中心患者钙磷代谢紊乱及继发性甲状旁腺功能亢进(secondary hyperparathyroidism,SHPT)控制达标情况,同时分析iPTH水平与钙、磷、白蛋白、内生肌酐清除率(creatinine clearance rate,Ccr)等的相关性,本研究对2011年1月至2012年7月期间在连云港市东部城区MHD患者进行分析,现报道如下.
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西拉卡塞抑制钙三醇无疗效的血液透析患者继发性甲状旁腺功能亢进一例
患者:男,39岁,继发性甲状旁腺功能亢进( secondary hyperparathyroidism,SHPT)1年余.2010年2月血全段甲状旁腺素(intact parathyroid hormone,iPTH) 571 pg/ml,限磷摄入,服钙三醇0.25μg/d.同年4月iPTH700 pg/ml,用罗盖全0.5 μg/d及碳酸钙,8月iPTH 926 pg/ml,11月iPTH达1 260 pg/ml.2011年2月血iPTH 1 145~1 260pg/ml,3月停服钙三醇,使用西拉卡塞30mg/d起,逐渐增加到60mg/d.6月17日iPTH411 pg/ml,8月3日iPTH268 pg/ml.
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1,25(OH)_2D_3对甲状旁腺激素诱导的肾小管上皮细胞转分化和转化生长因子β1表达的影响
甲状旁腺激素(PTH)能够诱导体外培养的人肾小管上皮细胞转分化成肌成纤维细胞、并促进致纤维化的细胞因子转化生长因子β1(TGF-β1)表达上调~([1,2]),因此,PTH可能是造成肾间质纤维化的重要因素之一.1,25(OH)2D3具有防治肾间质纤维化的潜能~([3]).本研究探讨1,25(OH)2D3抗肾间质纤维化作用的机制.
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不同甲状旁腺素水平尿毒症患者左心功能的比较
本研究观察不同甲状旁腺素(PTH)水平的尿毒症患者及健康人左心局部心肌舒缩功能的差异,为临床诊治尿毒症心肌病提供客观依据.
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不同透析膜对血磷和甲状旁腺素清除的比较
观察不同透析膜的透析器对血液透析患者血磷和甲状旁腺素(iPTH)清除的比较.
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甲状旁腺激素基因多态性对广东地区老年人骨密度的影响
目的:探讨甲状旁腺素(PTH)基因多态性与中国广东地区部分老年人群骨密度的相关性.方法:随机筛选广东老年人549例,年龄65~87岁,平均(71.03±7.37)岁,采用双能X线吸收测定其腰椎侧位、股骨颈、粗隆间、大转子、ward's三角等部位的骨密度值.用聚合酶链反应及限制性片段长度多态性技术检测外周血白细胞基因组PTH基因型.结果:549例受试对象中,PTH基因BB型382例,69.6%;Bb型148例,27.0%;和bb型19例,3.4%.无论是整个受试群体,还是根据性别将其分为男性及女性群体,其等位基因及基因型分布均符合Hardy-Wenbeng平衡定律.分析基因型与骨密度的关系显示,不同的基因型之间的骨密度均无统计学意义变化(P>0.05).结论:PTH基因多态性与广东地区汉族老年人群骨密度关系不密切,不能作为筛查和预示骨质疏松症的遗传易感位点.
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治疗骨质疏松症药物研究进展(二)
2 骨形成促进药物2.1 人重组甲状旁腺素1-34(Recombinant Human Parathyroid Hormone,rhPTH 1-34):人体天然甲状旁腺素(Parathyroid Hormone,PTH)含有84个氨基酸.人重组甲状旁腺素1-34具有与人体天然甲状旁腺素N端34个氨基酸序列完全相同的结构,其生物学作用亦是通过与特异性高亲和性人体天然甲状旁腺素-Ⅰ受体结合介导的.人重组甲状旁腺素1-34于2002年已获FDA批准上市,商品名为Forteo,是目前唯一促进骨形成的药物,其增加BMD及改善骨结构的作用优于目前广泛使用的抗骨吸收药物.
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The hypoxia inducible factors (Hifs) are evolutionarily conserved transcriptional factors that control homeostatic responses to low oxygen. In developing bone, Hif-1 generated signals induce angiogenesis necessary for osteoblast specification, but in mature bone, loss of Hif-1 in osteoblasts resulted in a more rapid accumulation of bone. These findings suggested that Hif-1 exerts distinct developmental functions and acts as a negative regulator of bone formation. To investigate the function of Hif-1a in osteoanabolic signaling, we assessed the effect of Hif-1a loss-of-function on bone formation in response to intermittent parathyroid hormone (PTH). Mice lacking Hif-1a in osteoblasts and osteocytes form more bone in response to PTH, likely through a larger increase in osteoblast activity and increased sensitivity to the hormone. Consistent with this effect, exposure of primary mouse osteoblasts to PTH resulted in the rapid induction of Hif-1a protein levels via a post-transcriptional mechanism. The enhanced anabolic response appears to result from the removal of Hif-1a-mediated suppression of b-catenin transcriptional activity. Together, these data indicate that Hif-1a functions in the mature skeleton to restrict osteoanabolic signaling. The availability of pharmacological agents that reduce Hif-1a function suggests the value in further exploration of this pathway to optimize the therapeutic benefits of PTH.
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Objective:To analyze the influence of hemoperfusion combined with hemodialysis on serum inflammatory factors, homocysteine (Hcy), parathyroid hormone (PTH) andβ2microglobulin (β2-MG) and other indexes in patients with chronic renal failure.Methods:94 cases with chronic renal failure from December 2013 to January 2015 in our hospital were randomly divided into two groups, according to the order of treatment. The control group of 47 patients with regular hemodialysis treatment, the observation group of 47 cases with blood perfusion combined with hemodialysis treatment. The serum interleukin-1 (IL-1), interleukin-6 (IL-6), tumor necrosis factorβ (TNF-β), high sensitive C reactive protein (hs-CRP), phosphorus (P), Hcy, PTH, BUN,β2-MG and Scr indexes of two groups of patients before and after treatment were detected.Results:After treatment, serum IL-1, IL-6, TNF-β and hs-CRP levels of observation group were (1.72±0.16) ng/L, (12.38±1.67) ng/L, (1.26±0.31) mg/L, (6.78±1.42) ng/mL, were significantly decreased compared with the group before treatmentand control group after treatment (P<0.05). After treatment, serum PTH, Hcy and P levels of observation group were (24.53±4.82) μmol/L, (21.65±2.38) pmol/L, (1.50±0.29) mmol/L, were significantly decreased compared with the group before treatment and control group after treatment (P<0.05). After treatment,β2-MG, BUN, Scr levels of observation group were (1.92±0.26) mg/L,(6.76±1.23) mmol/L, (410.62±13.20) μmol/L, were significantly decreased compared with the group before treatment and control group after treatment. The skin itching relieving rate of observation group was 91.49% (43/47) was significantly higher than the control groups’ 59.57% (19/47), the differences were statistically significant.Conclusion:The curative effect of blood perfusion combined with hemodialysis in the treatment of chronic renal failure is significant, can effectively reduce the serum level of inflammatory factors, can clean out Hcy, PTH,β2-MG significantly, and can effectively improve renal function and skin itching symptoms, is worthy of clinical popularization and application.