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目的 研究维生素D受体 (VDR)在继发性甲状旁腺功能亢进 (SHPT)患者甲状旁腺中的表达 ,探讨严重SHPT患者对钙三醇抵抗的机制以及与甲状旁腺增生的关系。方法 7例严重SHPT病人的甲状旁腺 19枚 ,正常对照 6枚 ,用免疫组化ABC法检测维生素D受体、细胞增殖核抗原(PCNA)表达。计算阳性细胞率。结果 SHPT组甲状旁腺总重量为正常对照的 16 1倍 ,两组PCNA表达分别为 (6 35± 3 36 )‰与 (1 73± 1 31)‰ ,结节性增生区增加更显著 (P <0 0 0 1) ,PCNA表达与甲状旁腺重量呈正相关 (r=0 5 8,P <0 0 1)。SHPT组VDR阳性率 (40 2 8± 13 13) %较对照组 (83 79±3 77) %明显减少 ,结节性较弥漫性增生更显著 ,为 (2 7 14± 4 12 ) %与 (49 84± 7 33) % (P值均 <0 0 0 1) ,VDR表达与腺体重量、PCNA阳性率均呈负相关 (r =- 0 46 ,P <0 0 5与r =- 0 75 ,P <0 0 0 1)。结论 严重SHPT患者甲状旁腺细胞VDR明显减少可能是导致对钙三醇抵抗的原因之一 ,且与细胞增殖有关
Objective To investigate the expression of vitamin D receptor (VDR) in the parathyroid gland of patients with secondary hyperparathyroidism (SHPT) and to explore the mechanism of calcitriol resistance in patients with severe SHPT and its relationship with hyperplasia of parathyroid glands. Methods Seventeen parathyroid glands in seven patients with severe SHPT and six normal controls were included. The expression of vitamin D receptor and proliferating cell nuclear antigen (PCNA) were detected by immunohistochemical ABC method. Calculate the positive cell rate. Results The total parathyroid gland weight in SHPT group was 16 1 times higher than that in normal control group. The expression of PCNA in the two groups was (6 35 ± 3 36) ‰ and (1 73 ± 1 31) ‰, respectively, and the nodular hyperplasia area increased more significantly There was a positive correlation between PCNA expression and parathyroid weight (r = 0 58, P 0 01). The positive rate of VDR in SHPT group (40 2 8 ± 13 13%) was significantly lower than that in control group (83 79 ± 3 77)%, and the nodularity was more significant than diffuse hyperplasia (2 7 14 ± 4 12)% vs 49 84 ± 7 33)% (P <0 0 01). The expression of VDR was negatively correlated with the weight of gland and the positive rate of PCNA (r = - 0 46, P 0 05 and r 0 0 75 , P <0 0 0 1). Conclusions The significant reduction of VDR in parathyroid cells in severe SHPT patients may be one of the reasons leading to calcitriol resistance and related to cell proliferation