次發性副甲狀腺機能亢進的治療

Medical Treatment of Secondary Hyperparathyroidism

劉峻瑋(Chun-Wei Liu) ； 鄭仲益(Chung-Yi Cheng) ； 陳作孝(Tso-Hsiao Chen)

《腎臟與透析》 27卷3期 (2015/09) Pp. 135-140

https://doi.org/10.6340/KD.2015.27(3).08

摘要

次發性副甲狀腺機能亢進是慢性腎臟病病患最常見的併發症之一，罹病患者易併發腎性骨病變及心血管疾病。其致病機轉主要為低血鈣、高血磷與活性維生素D的缺乏。傳統治療上以飲食與藥物來改善低血鈣與高血磷症，以活性維生素D治療維生素D缺乏，當病患發生高血鈣與血管鈣化副作用時，擬鈣劑則是另一種藥物的選擇，副甲狀腺切除術適應於藥物治療無效時。以酒精或是高濃度維生素D注射於副甲狀腺結節上，目前未有研究定論其長期療效。

關鍵字

副甲狀腺機能亢進 ； 纖維母細胞生長因子-23 ； 血磷

並列摘要

Secondary hyperparathyroidism is one of the most common complications in patients with chronic kidney disease. These patients frequently complicated with disorders of mineral and bone metabolism and cardiovascular disease. The pathophysiology of secondary hyperparathyroid disorder is complex and involves hypocalcemia, hyperphosphatemia and decreased calcitriol activity. The treatment of patients with hyperparathyroidism varies depending upon correction of hypocalcemia and hyperphosphatemia by restricting dietary phosphate intake, administering phosphate binders and vitamin D supplement in calcitriol deficiency. Calcimimetics is the alternative treatment in patients complicated with hypercalcemia. Parathyroidectomy is indicated when medical treatment fails. Efficacy of ultrasound-guided percutaneous ethanol or vitamin D injection therapy remained to be determined.

並列關鍵字

Hyperparathyroidism ； FGF-23 ； phosphate