继发性甲状旁腺功能亢进症常需大剂量维生素D治疗

时间 : 2009-12-03 07:48:40 来源：www.91sqs.com

[摘要]

Recommended daily vitamin D intakes are often insufficient to correct secondary hyperparathyroidism in patients with primary osteoporosis and osteopen

RecommendeddailyvitaminDintakesareofteninsufficienttocorrectsecondaryhyperparathyroidisminpatientswithprimaryosteoporosisandosteopenia,Canadianresearchersreport.

“TheOsteoporosisSocietyofCanadarecommendsthatpatientswithosteoporosistake800IUvitaminDdaily,”sayEdmundYendtandcolleaguesfromQueensUniversityinKingston,Ontario.

“Atbaseline,vitaminDintakesexceeded800IUdailyin19%ofourpatientswithsecondaryhyperparathyroidism,sothisdoseisclearlyinadequateforsomepatients,”theyadd.

Yendtandteammeasuredbiochemicalvariables,renalfunctionandcalciumandvitaminDintakesin218femalepatientswithprimaryosteoporosisorosteopenia.

Atbaseline,75patientshadparathyroidhormone（PTH）levelsintheuppersixthofthereferencerange,indicatinghyperparathyroidism.Theremaining143patientshadPTHlevelsintherestofthereferencerange.

Patientsweretreatedwitheither1000IUofvitaminD3dailyor50000IUofvitaminD2onceweeklyandfollowed-upafter1year.Inaddition,theresearchersfollowed-uppatientswithsecondaryhyperparathyroidismuntilPTHlevelsbecamenormal.

Inone-thirdofthehyperparathyroidpatients,thestandardbaselinetreatmentfailedtocorrectthesecondaryhyperparathyroidism,theresearchersreportinthejournalClinicalEndocrinology.

Specifically,unusuallyhighdosesofvitaminD（50000IUvitaminD2twiceweekly）wererequiredtorestoreserumPTHlevelstonormalinninepatientswithnoevidenceofceliacdiseaseorothermalabsorptivedisorders.

TherewerealsosixpatientswhoseserumPTHlevelsonlyreturnedtonormalwhensupplementalcalciumintheformofcalciumcarbonatewaschangedtocalciumcitrate.

Yendtetalconclude:“LargedosesofvitaminDarefrequentlynecessarytosuppresssecondaryhyperparathyroidisminpatientswithprimaryosteoporosisandosteopenia.ThissuggeststhatvitaminDmetabolismmaybealteredinsomeofthesepatients.”

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