二次性上皮小体機能亢進症における上皮小体摘除術前後の血清ピリジノリン類の経時的検討

Abstract

To investigate the clinical usefulness of pyridinium crosslinks, pyridinoline (Pyr)and deoxypyridinoline (Dpyr), novel markers of bone resorption, in evaluation of the state of renal osteodystrophy (ROD), serum concentrations of the crosslinks together with other known ROD markers were measured sequentially in patients with secondary hyper- parathyroidism (2°HPT) before and after parathyroidectomy (PTX). In six chronic hemodialysis patients with 2°HPT who underwent PTX and autotrans- plantation of a resected parathyroid gland from January through August 1994, serial measurement of serum Pyr, Dpyr, HS-PTH, alkaline phosphatase and osteocalcin was done. Similarly, serial measurement of urinary Pyr, Dpyr and other markers was done in two surgically-treated patients with primary hyperparathyroidism (1°HPT). The changes of these markers were evaluated in each patient and between the patients'with 1°HPT and 2°HPT. Before PTX, marked elevation of ROD markers including Pyr and Dpyr and severe bone changes indicative of the advanced ROD stage on plain X-ray films were observed in all patients with 2°HPT. The changes of Pyr after PTX were parallel to those of Dpyr. However, the reducing speed of Pyr and Dpyr varied among the patients : patients with lower Pyr and Dpyr levels before PTX showed a slower decrease of the crosslinks. All patients out of three in whom serial measurement of the markers in the early phase after PTX was done, alkaline phosphatase and/or osteocalcin showed a transient elevation without changes of Pyr and Dpyr levels. In pabients, the changes of alkaline phosphatase, osteocalcin and the crosslinks were parallel from three months after PTX. The similar changes of the markers including urinary Pyr and Dpyr to in patients with 2°HPT were observed in two patients with 1°HPT. The data suggest that the state of high turnover bone in 2°HPT would be improved associating with a decrease of PTH secretion after PTX, and bone formation might become dominant in the process of bone remodeling in the early phase after PTX. It is concluded that serial measurement of serum pyridinium crosslinks before and after PTX would be useful in evaluation of changes of ROD lesions in patients with 2°HPT.