2次性副甲状腺機能亢進症に対する内科的, 外科的治療効果と問題点

Abstract

Elcitonine療法群6例(1群), lpriflavon療法群5例(2群), Pulse療法(1.25(OH)2D3)群12例, PTX群16例について, 治療効果を血清学的並びに骨シンチ, 骨塩量(BMC)の推移より比較した.血清中PTH-C, ALPは増加していたがBMCは有意に減少し, 1年後には1群, 2群の患者はPulse療法, 副甲状腺剔出術(PTX)に変更せざるを得なかった.Pulse群では, 血清ALPは有意に減少していたが, 血清PTH-Cは8例で有意の低下, 30 ng/ml以上の4例では不変又は増加を示した.BMCの平均変化率は不変であった.PTX群では血清中PTH-C, ALP量は減少し, 6ヵ月以後BMC平均変化率は有意に増加した.以上より, PTH-Cレベルが30 ng/ml以上, 以下であっても, BMCの減少が顕著な症例には, PTXを早期より実行した方がよい

We compared the effect of conservative treatment with that of surgical treatment after applying them on secondary hyperparathyroidism patients (2nd HPT) in order to study the application of surgery on 2nd HPT patients. We selected the test subject of 39 maintenance dialysis patients with complications of 2nd HPT. The conservative treatments were; elcitonine administration (40 u x 3/W) (group 1), ipriflavon administration (200 mg x 3/day) (group 2), and pulse treatment (1.25 (OH)2D3 6 micrograms/W) (group 3). For surgical treatment, we adopted total parathyroidectomy with auto-transplantation into the arm (PTX). The transition of serum parathyroid hormone (PTH-C), alkali-phosphatase (ALP), bone scintigraphy of every 6 months, and change of bone mineral content (BMC) were compared to judge the effects of treatments. We measured 1/3, 1/6 radial region with single photon absorptiometry (SPA) and L3 region with dual photon absorptiometry (DPA) to obtain BMC. We were forced to transfer the patients in groups 1 and 2 (conservative treatment) to pulse treatment or PTX as 12 months later they showed increase in serum PTH-C, ALP and significant drop (P less than 0.05) in BMC average change rate (1/3). In group 3 of pulse treatment, though significant decrease in serum ALP (P less than 0.01) was detected for 10 cases out of 12, serum PTH-C was either unchanged or increased for 4 cases with the value of more than 30 ng/ml. Furthermore the average change rate of BMC stayed at the same level.(ABSTRACT TRUNCATED AT 250 WORDS)