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了解内分泌激素：甲状旁腺激素

2021-12-30 检验之声 网络

内分泌激素
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骨是体内最大的钙贮存库，PTH可提高破骨细胞的生物学活性, 促进骨吸收过程, 使骨钙释放入血, 血钙升高

 

甲状旁腺激素（parathyroid hormone，PTH），人体内重要的激素之一，由甲状旁腺主细胞分泌，主要通过肾脏、骨骼及肠道对血钙、血磷进行调节，具有升高血钙、降低血磷、调节骨代谢的作用。
PTH 调节钙磷的 3 种方式
1、通过肾脏调节：PTH促进肾远曲小管和集合管对钙的重吸收,减少尿钙排泄,升高血钙。PTH抑制近端和远端小管对磷的重吸收,促进尿磷的排泄，使血磷降低。
2、通过骨的调节：骨是体内最大的钙贮存库，PTH可提高破骨细胞的生物学活性, 促进骨吸收过程, 使骨钙释放入血, 血钙升高；增加成骨细胞数量, 提高成骨细胞产生和释放，增加骨生长因子的能力, 促进骨形成以及增加骨量。
快速效应：几分钟，经钙离子泵活动，使血钙升高；
延缓效应：几日、几周，因破骨细胞活动增加，骨溶解，血钙、血磷增高。
3、通过小肠调节：PTH 通过激活肾内 1ɑ-羟化酶，促进小肠粘膜对钙、磷的吸收。
PTH 的分泌、调节特点
1、PTH 分泌呈节律性波动，早晨 6 时浓度最高，午后 4 时浓度最低，在肝灭活，经肾排出。
2、PTH主要的生理作用是升高血钙，降低血磷。血钙和血磷的浓度又通过反馈机制，影响PTH的分泌。当血钙下降时，会促使PTH分泌；当血钙升高时，会抑制PTH分泌；还有当血磷升高时，也会促使PTH分泌。于是钙、磷和PTH就组成了一个“相爱相杀”的复杂关系。
3、长期低血钙使甲状旁腺增生，长期高血钙会使甲状旁腺萎缩。
面对 PTH 的改变，需要考虑的疾病
PTH增高
1、原发性甲状旁腺功能亢进：甲状旁腺组织原发病变导致甲状旁腺PTH分泌过多，导致肾钙重吸收和尿磷排泄增加，引起高钙低磷血症、肾结石等。病理改变有腺瘤、增生和腺癌3种，其中腺瘤最常见，约占78％～90％，大多为单个；增生约占10％～20％，常累及4个甲状旁腺；腺癌约占3％，发展缓慢，但可有淋巴或远处转移。
2、继发性甲状旁腺功能亢进：各种原因引起的低钙血症刺激甲状旁腺肥大增生，导致PTH分泌过多甲旁亢，常见于慢性肾病、骨软化症、肠吸收不良综合征维生素D缺乏等。
3、三发性甲状旁腺功能亢进：由于长期的慢性继发性甲旁亢存在，当甲状旁腺长期受刺激形成自主结节或腺瘤，此时PTH呈自主性分泌、不受血钙调节时的一种状况。当原发病解除后，甲状旁腺功能亢进症不能恢复。常见于慢性肾功能不全、透析病人。
PTH 降低
1、甲状旁腺功能减退：PTH分泌过少或效应不足而引起的一组临床综合征。其临床特征有低钙血症、高磷血症和由此引起的神经肌肉兴奋性增高及软组织异位钙化等。多见于甲状腺、甲状旁腺、咽喉或其他颈部疾病术后，此种状态术后超过6-12个月即可诊断为永久性甲状旁腺功能减退。
2、假性甲状旁腺功能减退症：PHP属于遗传性疾病，患者的甲状旁腺激素受体异常，周围器官（骨、肾）对甲状旁腺激素无反应或反应降低（PTH抵抗），所以患者的临床表现是甲旁减，生化表现血钙降低，血磷升高，但是甲状旁腺激素是升高。
当发现体内钙、磷离子异常时就要引起注意，及时监测 PTH 浓度，而当 PTH 出现异常时，就需要综合考虑，除了想到甲状旁腺本身的病变外，还需要考虑到肾脏系统、骨骼系统、肿瘤等问题，尽快完善相关检查，明确病因，针对原发病进行根本性治疗。

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编辑：青翠欲滴

审校：晨晨

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    2022-09-14 gwc392

    #分泌#

    0

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    2021-12-31 huperzia

    #甲状旁腺#

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    2021-12-31 查查佳佳

    骨是体内最大的钙贮存库，PTH可提高破骨细

    0

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    2021-12-30 ms4000000609908410

    学习

    0

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