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目的 研究维生素D受体 (VDR)在继发性甲旁亢 (SHPT)患者甲状旁腺 (PT)中的表达 ,探讨严重继发性甲旁亢患者对钙三醇抵抗的机制以及与PT增生的关系。方法 7例严重SHPT病人的PT19枚 ,正常人 6枚 ,用免疫组化ABC法检测细胞增殖核抗原 (PCNA)、维生素D受体表达 ,计算阳性细胞率。结果 SHPT组PT总重比正常人增加 16 1倍 ,PCNA表达明显增加 ,分别为 (6 35± 3 36 )‰和 (1 73± 1 31)‰ (P<0 0 0 1)。结节性增生区 (NH)增加更为显著 (P <0 0 0 1) ,PCNA表达与腺体重量呈正相关 (r =0 58,P <0 0 1)。SHPT组VDR阳性率 (4 0 2 8± 13 13) %比对照组 (83 79± 3 77) %明显减少 (P <0 0 0 1)。结节性较弥漫性增生减少更显著 ,为 (2 7 14± 4 12 ) %和 (4 9 84± 7 33) % (P <0 0 0 1)。VDR表达与腺体重量、PCNA阳性率均呈负相关(r=- 0 4 6 ,P <0 0 5与r =- 0 75,P <0 0 0 1)。结论 SHPT甲旁腺VDR表达明显减少 ,结节性较弥漫性增生更甚 ,与PCNA阳性率呈负相关。提示严重SHPT患者PT细胞VDR明显减少可能是导致对钙三醇抵抗的重要原因 ,且与细胞增殖有关。
Objective To investigate the expression of vitamin D receptor (VDR) in parathyroid (PT) of patients with secondary hyperparathyroidism (SHPT) and to explore the mechanism of calcitriol resistance in patients with severe secondary hyperparathyroidism and its relationship with PT hyperplasia Relationship. Methods Seven patients with severe SHPT had PT19 and six normal controls. The expressions of proliferating cell nuclear antigen (PCNA) and vitamin D receptor were detected by immunohistochemical ABC method, and the positive cell rate was calculated. Results The total PT in SHPT group was 16 1 times higher than that in normal subjects, and the expression of PCNA in SHPT group was significantly increased (6 35 ± 3 36) ‰ and (1 73 ± 1 31) ‰ (P 0 01), respectively. The nodular hyperplasia (NH) increased more significantly (P <0.01). The expression of PCNA was positively correlated with the weight of the gland (r = 588, P <0.01). The positive rate of VDR in SHPT group (40 02 ± 13 13)% was significantly lower than that in control group (83 79 ± 3 77)% (P 0 01 01). Nodularity was more significant than diffuse hyperplasia (2 7 14 ± 4 12)% and (4 9 84 ± 7 33)% (P 0 01). VDR expression was negatively correlated with gland weight and PCNA positive rate (r = - 0 46, P 0 05 and r 0 0 75, P 0 01). Conclusion The expression of VDR in parathyroid glands of SHPT is obviously decreased, the nodularity is more diffuse hyperplasia, and negatively correlated with the positive rate of PCNA. These results suggest that the significant decrease of VDR of PT cells in severe SHPT patients may be the important reason leading to the resistance to calcitriol, which is related to cell proliferation.