Abstract
Aim. To evaluate the effect of local vitamin D injections into parathyroid glands on laboratory markers and survival in refractory hyperparathyroidism. Materials and methods. A comparison of the dynamics of secondary hyperparathyroidism laboratory markers and survival was performed in 37 patients with local vitamin D injections into the parathyroid glands under ultrasound guidance and in 62 patients with PTH higher than 600 pg/ml without reduction in PTH levels by more than 10% during 6 months, who continued to receive available conservative therapy. The mean duration of follow-up for groups was 40.5 and 33.2 months, respectively.Results. In the local injection group (LIG) PTH level reduced by 347 ± 360 pg/ml (38%) during the first month after injection course, and by 214 ± 255 pg/ml (28%) between annual average levels before and after injection course, while in control group (CG) it rose by 84 ± 277 pg/ml (11%). In LIG phosphate level significantly reduced by 0.18 ± 0.24 mmol/l (9%) after injection course and annual average level did not change. In CG annual average phosphate level significantly rose by 0.15 ± 0.37 mmol/l (7%). Cumulative survival by Kaplan–Maier was significantly higher in LIG (p = 0.025). Differences in survival in univariate and multivariate Cox regression models were significantly associated only with the fact of local injections course (p =0.04 inboth models).Conclusion. In current clinical practice the application of ultrasound-guided local vitamin D injections into parathyroid glands in patients with refractory hyperparathyroidism leads to a better control over laboratory markers and to significantly improved survival.
Highlights
В рамках текущей клинической практики применение местных инъекций препаратов активной формы витамина D в паращитовидные железы под контролем УЗИ при рефрактерном вторичном гиперпаратиреозе приводит к улучшению контроля лабораторных маркеров вторичного гиперпаратиреоза (ПТГ и фосфатов) и значимому улучшению выживаемости
A comparison of the dynamics of secondary hyperparathyroidism laboratory markers and survival was performed in 37 patients with local vitamin D injections into the parathyroid glands under ultrasound guidance and in 62 patients with PTH higher than 600 pg/ml without reduction in PTH levels by more than 10% during 6 months, who continued to receive available conservative therapy
Cumulative survival by Kaplan–Maier was significantly higher in local injection group (LIG) (p = 0.025)
Summary
Одной из проблем терапии вторичного гиперпаратиреоза является развитие узловой паратиреоидной гиперплазии со снижением количества рецепторов к витамину D и кальцию [7], через которые опосредовано действие известных препаратов для лечения вторичного гиперпаратиреоза, что приводит к уменьшению чувствительности к медикаментозной терапии. В случае неэффективности проводимой медикаментозной терапии и выявления одной или двух увеличенных в размерах паращитовидных желез, доступных для пункции под контролем УЗИ, эффективным может быть выполнение местных инъекций этанола или активаторов рецепторов витамина D в паращитовидные железы с целью восстановления чувствительности к проводимой терапии [14]. В одной из наших работ была показана возможность применения местных инъекций препаратов активной формы витамина D в паращитовидные железы малого размера под контролем УЗИ [18]. Для сравнения двух подходов терапии вторичного гиперпаратиреоза в реальной клинической практике было выполнено проспективное исследование по сравнению их влияния на динамику лабораторных показателей МКН ХБП и выживаемость
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