CAJ | 학술논문

目的探讨特发性甲状旁腺功能减退症(IHP)的病因、临床特点及治疗.方法回顾性分析天津医科大学总医院内分泌科10年的IHP住院病例,共收集24例,其中6例行肌肉活检,10例(41.67%)合并其他自身免疫相关性疾病.免疫抑制组(6例)应用钙剂、活性维生素D、维生素D3和醋酸泼尼松治疗,传统治疗组(18例)应用钙剂、活性维生素D和维生素D3治疗.在上述两组中选择病史、体重和用药剂量相匹配的病例,比较治疗1周时血钙、磷和尿钙、磷的变化幅度.结果 6例肌肉活检均发现肌纤维肿胀,免疫复合物沿肌细胞膜沉积.两组患者中病史、体重和用药剂量相匹配的10例患者进行比较发现:治疗1周时,免疫抑制组的血钙、尿钙升高幅度明显大于传统治疗组(P＜0.01),血磷和尿磷变化幅度无统计学差异(P＞0.05).结论 IHP的病因可能与自身免疫有关,易合并其他自身免疫相关的疾病;加用糖皮质激素(醋酸泼尼松)治疗有利于血钙、尿钙快速上升.
목적 탐토특발성갑상방선공능감퇴증(IHP)적병인、림상특점급치료.방법 회고성분석천진의과대학총의원내분비과10년적IHP주원병례,공수집24례,기중6례행기육활검,10례(41.67%)합병기타자신면역상관성질병.면역억제조(6례)응용개제、활성유생소D、유생소D3화작산발니송치료,전통치료조(18례)응용개제、활성유생소D화유생소D3치료.재상술량조중선택병사、체중화용약제량상필배적병례,비교치료1주시혈개、린화뇨개、린적변화폭도.결과 6례기육활검균발현기섬유종창,면역복합물연기세포막침적.량조환자중병사、체중화용약제량상필배적10례환자진행비교발현:치료1주시,면역억제조적혈개、뇨개승고폭도명현대우전통치료조(P＜0.01),혈린화뇨린변화폭도무통계학차이(P＞0.05).결론 IHP적병인가능여자신면역유관,역합병기타자신면역상관적질병;가용당피질격소(작산발니송)치료유리우혈개、뇨개쾌속상승.
Objective To study the pathogenesis,clinical characteristics,and therapy of idiopathic hypoparathyroidism.Methods 24 patients with idiopathic hypoparathyroidism,hospitalized in the general hospital of Tianjin Medical University in the last ten years,were colleeeted retrospectively.Among these patients,6 patients were biopsied,10 patients (41.67%) were associated with other autoimmune related diseases.Calcium,calcitriol,VitD3 and prednisone were administrated in the immunosuppressive group(6 cases),while prednisone were not administrated in the traditional management group(18 cases).In the two groups,the patients,whose history,weight and medicine dose were matched,were choosed.After 1 week,the changes of calcium in serum and urine and the changes of phosphorus in serum and urine were compared.Results Muscle fiber swelling and immune complexes were found around perimysia by pathology and immunohitochemistry.In the two groups,10 cases were matched.After one week administration,the changes of calcium in serum and urine of the immunosuppressive group were more obvious than those of the traditional management group(P<O.01).There were no statistic difference between the two groups about the chauges of phosphorus in serum and urine.Conclusion Our results showed that the majority of idiopathic hypoparathyroidism might be due to autoimmune injuries and somehow associated with other autoimmune related di$eases.Glucocorticoids,as an immunodepressive agent,may be more helpful to deal with the hypocalcemia of idiopathic hypo-parathyroidism than traditional methods.