二次性上皮小体機能亢進症に対する活性型ビタミンDパルス療法の経験

Abstract

1)2°HPT 20例に活性型VDのパルス療法を実施した.13例に有効であり保存的に治療が可能であったが, 無効の6例と, 1例が再発を繰り返すため最終的に7例にPTXを実施した.2)パルス療法有効例でも, 治療に伴い全例で平均1.8±1.0mg/dlの血清Ca値の上昇が認められた.3)パルス療法無効例は有効例と比較して, 有意に上皮小体が大きかった.又, 血清Ca, P, Alpも有意に高かった.4)PTXを実施した7例では, 5例までがその最大の上皮小体が1gを超え, 組織学的に結節性過形成を呈した.5)PTX直前まで可能なかぎり活性型VDを投与して, 血清Alpを低下させた.術後の経静脈的Ca投与量は術直前の血清Alpと相関し, Alpを下げることで, 術後の血清Caの管理が容易であった可能性がある

The oral active vitamin D pulse therapy was performed for 20 chronic hemodialysis patients with secondary hyperparathyroidism (2 degrees HPT). Before pulse therapy, all patients showed high-turnover bone diseases, elevated serum alkaline phosphatase (Alp) and elevated serum parathyroid hormone (PTH). They had at least one parathyroid gland detected by ultrasonography. In one patient, serum PTH level did not decrease during three months. In five patients, hypercalcemia was observed so that the pulse therapy was with drawn. Another patient was resistant to the second pulse therapy for recurrence of 2 degrees HPT. Total parathyroidectomy and autotransplantation was performed in these seven patients. The size of parathyroid gland in patients undergoing surgical treatment was significantly larger than those estimated by ultrasonography in patients successfully treated with pulse therapy (p < 0.005). In all patients with surgical treatment, the conventional oral active vitamin D therapy was performed with caution to hypercalcemia preoperatively. The preoperative Alp levels decreased compared with those of at the beginning of the pulse therapy. Postoperatively, the total amount of intravenous administered calcium decreased, and serum calcium levels were easily controlled.