腎性副甲狀腺機能亢進的機轉與治療

Pathophysiology and Management of Renal Hyperparathyroidism

鄭世平(Shih-Ping Cheng) ； 楊圳隆(Tsen-Long Yang) ； 李居仁(Jie-Jen Lee) ； 吳志仁(Chih-Jen Wu) ； 陳逸洲(Yi-Chou Chen) ； 葉瑞圻(Jui-Chi Yeh) ； 陳漢湘(Han-Hsiang Chen)

《內科學誌》 20卷1期 (2009/02) Pp. 30-35

https://doi.org/10.6314/JIMT.2009.20(1).04

摘要

慢性腎病患者常見次發性副甲狀腺機能亢進，可能導致腎性骨病變及心血管併發症。其致病機轉主要爲活性維生素D不足及目標組織對副甲狀腺素產生抗性所引發的低血鈣，加上腎病後期的血磷滯留，合併刺激副甲狀腺增生。隨著疾病逐漸進展，副甲狀腺增生進而產生結節變化，同時伴隨鈣敏感受體及維生素D受體的表現減少。傳統治療方式包括限磷飲食、磷結合藥物及活性維生素D治療在疾病早期有不錯的控制效果，但可能增加高血鈣及鈣磷乘積上升的危險，引發血管鈣化。當傳統治療方式無法再有效控制副甲狀腺機能亢進時，應考慮進一步積極的治療如酒精注射或副甲狀腺手術，以避免不可逆的併發症產生。目前新的治療藥物擬鈣劑則有待進一步研究。

關鍵字

慢性腎病 ； 尿毒症 ； 副甲狀腺機能亢進 ； 副甲狀腺素 ； 結節增生

並列摘要

Secondary hyperparathyroidism commonly develops in patients with chronic kidney disease, leading to mineral and bone disorder and cardiovascular complications. Hypocalcemia resulting from calcitriol deficiency and tissue-resistance to parathyroid hormone, as well as hyperphosphatemia are the main causes of secondary hyperparathyroidism. With the progression of hyperparathyroidism, a nodular pattern of parathyroid gland hyperplasia arises in association with downregulation of calcium-sensing receptor and vitamin D receptor. Conventional treatment with dietary phosphorus restriction, phosphate binders and active vitamin D analogs has moderate efficacy but is also accompanied with adverse effects including hypercalcemia and increased calciumphosphorus product, a known risk factor for vascular calcification. To minimize irreversible complications, aggressive treatment including percutaneous alcohol injection and parathyroidectomy should be considered when hyperparathyroidism is refractory to medical treatment. Calcimimetic agent is a new type of therapeutic drug and deserves further investigation.

並列關鍵字

Chronic kidney disease ； Uremia ； Hyperparathyroidism ； Parathyroid hormone ； Nodular hyperplasia