腎と骨代謝 Vol.21 No.3(8)


連載名 [連載]Clinical Investigation
題名 腎性副甲状腺機能亢進症PTx症例における1-84PTH測定の意義
発刊年月 2008年 07月
著者 松岡 慎 名古屋第二赤十字病院移植・内分泌外科
著者 冨永 芳博 名古屋第二赤十字病院移植・内分泌外科
著者 宇野 暢晃 名古屋第二赤十字病院移植・内分泌外科
著者 佐藤 哲彦 名古屋第二赤十字病院移植・内分泌外科
【 要旨 】 [背景]1-84PTH測定が可能となり,各分野でその臨床的位置付けが報告されている.[目的]腎性副甲状腺機能亢進症 (2HPT) に対する,副甲状腺摘出術 (PTx) 時における1-84PTH測定の意義を明らかにする.[対象・方法]当科にて2HPTにてPTxを施行した70例に対し,PTx前,PTx術後1日目において,intact PTHおよびwhole PTHを透析前に測定した.intact PTHはさらにPTx術後1ヵ月後,術後3ヵ月後にも測定した.これらのdata間,intact PTHとwhole PTHの比,PTxにて摘出した副甲状腺摘出腺総重量とPTHおよびその比との関係を検討した.[結果]摘出腺総重量が増加するにつれ,intact PTHに対するwhole PTHの比が減少した (r = -0.287, p = 0.0165).術前intact PTHが高値になるにつれ,intact PTHに対するwhole PTHの比が減少した (r = -0.341, p = 0.0040).術後1日目のintact PTHと術後1日目のwhole PTHは,術後1ヵ月目のintact PTHや術後3ヵ月目のintact PTHと相関するが,相関係数には違いがなかった.[結語]PTxにて摘出した副甲状腺総重量が増加するにつれ,総PTHは高くなるが,非活性型の占める割合が増える.
Series [Series]Clinical Investigation
Title Efficacy of 1-84 PTH assays in uremic patients with secondary hyperparathyroidism who have undergone PTx
Author Susumu Matsuoka Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital
Author Yoshihiro Tominaga Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital
Author Nobuaki Uno Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital
Author Tetsuhiko Sato Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital
[ Summary ] [Background] 1-84 PTH assays detect full length PTH peptides and allow for precise diagnosis of abnormal PTH secretion. [Purpose] The present study was designed to clarify the efficacy of 1-84 PTH assays for uremic patients with secondary hyperparathyroidism (2HPT) who have undergone parathyroidectomy (PTx). [Subjects and Method] Seventy patients who underwent initial PTx were enrolled in this study. We measured serum PTH levels through intact PTH assays and whole PTH assays capable of detecting circulating 1-84 PTH peptides before and after PTx (day 1). We also measured PTH levels through the intact PTH assays 1 month and 3 months after PTx. We also analyzed the ratio of whole PTH to intact PTH and explored the relationship of that ratio with the total weight of parathyroid glands at the time of PTx. [Result] The total weight of parathyroid glands correlated negatively with the ratios of whole PTH to intact PTH levels (r = -0.287, p = O.O165). Interestingly, that whole-intact PTH ratio had a negative relationship with preoperative intact PTH (r = -0.341, p = 0.0040). [Conclusion]As the total weight of parathyroid glands increased, intact PTH increased, and the whole PTH / intact PTH ratio decreased. Taken together, parathyroid gland growth may negatively regulate fragment PTH / full-length PTH secretion in 2HPT.
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