2022 年第 5 期 第 17 卷

慢性肾脏病伴继发性甲状旁腺功能亢进的研究进展

Research progress of chronic kidney disease complicated with secondary hyperparathyroidism

作者：邓晓清1李治荣2

英文作者：Deng Xiaoqing1 Li Zhirong2

单位：1重庆医科大学附属第一医院肾脏内科，重庆400016；2陆军军医大学大坪医院乳腺甲状腺外科，重庆400042

英文单位：1Department of Nephrology the First Affiliated Hospital of Chongqing Medical University Chongqing 400016 China; 2Department of Breast and Thyroid Surgery Daping Hospital Army Medical University Chongqing 400042 China

关键词：慢性肾脏病；继发性甲状旁腺功能亢进症；钙敏感受体；拟钙制剂；甲状旁腺切除

英文关键词：Chronickidneydisease;Secondaryhyperparathyroidism;Calcium-sensingreceptor;Calcimimetics;Parathyroidectomy

• 摘要：

• 继发性甲状旁腺功能亢进是慢性肾脏病患者对钙、磷和维生素D代谢紊乱所表现出的一系列病理生理反应，并随肾脏疾病的发展而进展。低钙、高磷及维生素D的活化缺陷可引起代偿性甲状旁腺激素分泌增加和甲状旁腺细胞过度增殖，从而引起继发性甲状旁腺功能亢进。近期有部分新的研究进一步揭示了钙敏感受体、维生素D受体的异常和成纤维细胞生长因子23与甲状旁腺功能失调之间的关系。治疗继发性甲状旁腺功能亢进的关键在于维持血清钙、磷和维生素D3水平在正常范围并控制甲状旁腺激素水平。目前，磷酸盐结合剂、拟钙制剂和维生素D等药物在内科治疗方面均显示出其延缓疾病进程的能力，然而，部分难治性甲状旁腺功能亢进的患者仍然需要外科手术治疗。本文将综述关于慢性肾脏病伴继发性甲状旁腺功能亢进的发病机制和治疗的相关进展。

• Secondary hyperparathyroidism is a series of pathophysiological reactions shown by patients with chronic kidney disease complicated with calcium, phosphorus and vitamin D metabolism disorders, and it progresses with the development of kidney disease. Low calcium, high phosphorus and vitamin D activation defects can cause increased secretion of compensatory parathyroid hormone and excessive proliferation of parathyroid cells, thereby causing secondary hyperparathyroidism. Recently, some new studies have further revealed the relationship between calcium-sensing receptor, vitamin D receptor abnormalities, fibroblast growth factor 23 and parathyroid dysfunction. The key to the treatment of secondary hyperparathyroidism is to maintain the serum levels of calcium, phosphorus and vitamin D3 in the normal range and to control the parathyroid hormone level. At present, drugs such as phosphate binders, calcimimetics and vitamin D have shown their ability to delay the progression of the disease in medical treatment. However, some patients with refractory hyperparathyroidism still require surgical treatment. This article summarizes the progress in the pathogenesis and treatment of chronic kidney disease complicated with secondary hyperparathyroidism.