<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE article PUBLIC "-//NLM//DTD JATS (Z39.96) Journal Publishing DTD v1.3 20210610//EN" "JATS-journalpublishing1-3.dtd">
<article article-type="research-article" dtd-version="1.3" xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xml:lang="ru"><front><journal-meta><journal-id journal-id-type="publisher-id">nid</journal-id><journal-title-group><journal-title xml:lang="ru">Нефрология и диализ</journal-title><trans-title-group xml:lang="en"><trans-title>Nephrology and Dialysis</trans-title></trans-title-group></journal-title-group><issn pub-type="ppub">1680-4422</issn><issn pub-type="epub">2618-9801</issn><publisher><publisher-name>Российское диализное общество</publisher-name></publisher></journal-meta><article-meta><article-id custom-type="elpub" pub-id-type="custom">nid-468</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group><subj-group subj-group-type="section-heading" xml:lang="ru"><subject>ТЕМА НОМЕРА - ОРИГИНАЛЬНЫЕ СТАТЬИ</subject></subj-group></article-categories><title-group><article-title>Коррекция умеренного вторичного гиперпаратиреоза местными инъекциями препаратов витамина D в паращитовидные железы</article-title><trans-title-group xml:lang="en"><trans-title>The correction of secondary hyperthyroidism by local vitamin D injection in parathyroid glands</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Герасимчук</surname><given-names>Р. П.</given-names></name><name name-style="western" xml:lang="en"><surname>Gerasimchuk</surname><given-names>R. P.</given-names></name></name-alternatives><email xlink:type="simple">romger@rambler.ru</email><xref ref-type="aff" rid="aff-1"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Кондаков</surname><given-names>С. Б.</given-names></name><name name-style="western" xml:lang="en"><surname>Kondakov</surname><given-names>S. B.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-2"/></contrib><contrib contrib-type="author" corresp="yes"><name-alternatives><name name-style="eastern" xml:lang="ru"><surname>Земченков</surname><given-names>А. Ю.</given-names></name><name name-style="western" xml:lang="en"><surname>Zemchenkov</surname><given-names>A. Yu.</given-names></name></name-alternatives><email xlink:type="simple">noemail@neicon.ru</email><xref ref-type="aff" rid="aff-3"/></contrib></contrib-group><aff-alternatives id="aff-1"><aff xml:lang="ru"><institution>СПб ГБУЗ «Городская Мариинская больница» - Городской нефрологический центр; Северо-Западный ГМУ им. И.И. Мечникова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>City Mariinsky hospital - City nephrology center; I.I. Mechnikov North-West State medical university</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-2"><aff xml:lang="ru"><institution>СПб ГБУЗ «Городская Мариинская больница» - Городской нефрологический центр</institution><country>Россия</country></aff><aff xml:lang="en"><institution>City Mariinsky hospital - City nephrology center</institution><country>Russian Federation</country></aff></aff-alternatives><aff-alternatives id="aff-3"><aff xml:lang="ru"><institution>СПб ГБУЗ «Городская Мариинская больница» - Городской нефрологический центр; Северо-Западный ГМУ им. И.И. Мечникова; Первый СПб ГМУ им. акад. И.П. Павлова</institution><country>Россия</country></aff><aff xml:lang="en"><institution>City Mariinsky hospital - City nephrology center; I.I. Mechnikov North-West State medical university; I.P. Pavlov First St.-Petersburg State medical university</institution><country>Russian Federation</country></aff></aff-alternatives><pub-date pub-type="collection"><year>2015</year></pub-date><pub-date pub-type="epub"><day>19</day><month>08</month><year>2024</year></pub-date><volume>17</volume><issue>1</issue><fpage>58</fpage><lpage>66</lpage><permissions><copyright-statement>Copyright &amp;#x00A9; Герасимчук Р.П., Кондаков С.Б., Земченков А.Ю., 2024</copyright-statement><copyright-year>2024</copyright-year><copyright-holder xml:lang="ru">Герасимчук Р.П., Кондаков С.Б., Земченков А.Ю.</copyright-holder><copyright-holder xml:lang="en">Gerasimchuk R.P., Kondakov S.B., Zemchenkov A.Y.</copyright-holder><license xml:lang="ru" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>Данная работа распространяется под лицензией Creative Commons Attribution 4.0.</license-p></license><license xml:lang="en" license-type="creative-commons-attribution" xlink:href="https://creativecommons.org/licenses/by/4.0/" xlink:type="simple"><license-p>This work is licensed under a Creative Commons Attribution 4.0 License.</license-p></license></permissions><self-uri xlink:href="https://journal.nephro.ru/jour/article/view/468">https://journal.nephro.ru/jour/article/view/468</self-uri><abstract><p>Цель работы: продемонстрировать эффективность коррекции вторичного гиперпаратиреоза малоинвазивным методом и определить оптимальные условия его применения. Методы: 37 пациентам с ХБП 5 ст., получающим заместительную терапию функции почек диализом (16 - ГД, 21 - ПАПД), с проявлениями вторичного гиперпаратиреоза, не поддающегося медикаментозной терапии, выполнено 46 серий местных инъекций парикальцитола в паращитовидные железы под контролем УЗИ на фоне стабильной терапии вторичного гиперпаратиреоза. Результаты: В результате вмешательств отмечалось статистически значимое снижение уровня ПТГ в среднем на 22,7% (190 пг/мл, 95% ДИ - 87÷293, p=0,001). Были выявлены значимые различия трендов уровней ПТГ до и после вмешательства за 6 и за 12 месяцев. При контрольном УЗИ через 6 месяцев после выполнения местных инъекций в паращитовидные железы определялось значимое уменьшение максимального линейного размера (в среднем на 17,1%) и тенденция к снижению расчетного объема железы (в среднем на 12,5%). При проведении регрессионного анализа выявлена статистически значимая зависимость изменения объема железы после вмешательства от ее размера до вмешательства в модели квадратичной регрессии. Наибольшее уменьшение объема отмечалось при исходном расчетном объеме железы от 0,2 до 0,5 см3. При расчетном объеме железы менее 0,1 см3 уменьшения железы в объеме не происходило. Различий в динамике уровня ПТГ в зависимости от исходного расчетного объема железы не выявлено. Выводы: Повторные инъекции витамина D в паращитовидные железы под УЗИ-контролем при размерах желез 0,2-0,5 см3 и при уровне паратгормона менее 1000 пг/мл могут в сочетании с медикаментозной терапией обеспечить контроль вторичного гиперпаратиреоза.</p></abstract><trans-abstract xml:lang="en"><p>Aim: The study was performed to show the efficiency of local vitamin D3 injection in parathyroid glands in management of secondary hyperparathyroidism and to reveal optimal conditions for this treatment. Results: Forty-six series of local injection of paricalcitol in the parathyroid gland under ultrasound guidance where performed in 37 patients with CKD 5D, receiving renal replacement therapy (16 - HD, 21 - CAPD) with manifestations of secondary hyperparathyroidism resistant to conservative therapy. As a result of the interventions a statistically significant reduction in PTH levels by 22.7% (190 pg/ml, 95% CI - 87 ÷ 293, p=0.001) was achieved. A significant difference in the trends of PTH before and after the intervention during 6 and 12 months was observed. A significant reduction of the maximal linear dimension (in average by 17.1%) and a downward trend in the estimated volume (in average by 12.5%) were revealed in 6 months after the injections. Regression analysis showed a statistically significant dependence of the gland volume changes upon the calculated gland volume before the intervention in the quadratic regression model. The most significant decrease in the volume was noted at the baseline calculated gland volume from 0.2 to 0.5 cm3. No gland volume reduction was found if the calculated volume was less than 0.1 cm3. The magnitude of the PTH level changes did not depend on the baseline calculated parathyroid gland volume. Conclusion: Repeated vitamin D injections in parathyroid glands under ultrasound control can be efficient treatment additional to medicamentous therapy when the glands size is in range 0.2-0.5 sm3 and the PTH level is lower 1000 pg/ml.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>вторичный гиперпаратиреоз</kwd><kwd>малоинвазивные вмешательства</kwd><kwd>активаторы рецепторов витамина D</kwd><kwd>паращитовидные железы</kwd><kwd>secondary hyperparathyroidism</kwd><kwd>low invasive intervention</kwd><kwd>vitamin D receptor activator</kwd></kwd-group></article-meta></front><back><ref-list><title>References</title><ref id="cit1"><label>1</label><citation-alternatives><mixed-citation xml:lang="ru">Бикбов Б.Т. Томилина Н.А. Заместительная терапия больных с хронической почечной недостаточностью в Российской Федерации в 1998-2011 гг. (Отчет по данным Российского регистра заместительной почечной терапии. Часть первая). Нефрология и диализ. 2014. 16(1): 11-127.</mixed-citation><mixed-citation xml:lang="en">Бикбов Б.Т. Томилина Н.А. Заместительная терапия больных с хронической почечной недостаточностью в Российской Федерации в 1998-2011 гг. (Отчет по данным Российского регистра заместительной почечной терапии. Часть первая). Нефрология и диализ. 2014. 16(1): 11-127.</mixed-citation></citation-alternatives></ref><ref id="cit2"><label>2</label><citation-alternatives><mixed-citation xml:lang="ru">Герасимчук Р., Земченков А., Кондаков С., Медведева Е. Малоинвазивный метод коррекции вторичного гиперпаратиреоза при хронической болезни почек. Врач. 2009. 11:15-22.</mixed-citation><mixed-citation xml:lang="en">Герасимчук Р., Земченков А., Кондаков С., Медведева Е. Малоинвазивный метод коррекции вторичного гиперпаратиреоза при хронической болезни почек. Врач. 2009. 11:15-22.</mixed-citation></citation-alternatives></ref><ref id="cit3"><label>3</label><citation-alternatives><mixed-citation xml:lang="ru">Ермоленко В.М., Волгина Г.В., Добронравов В.А. и др. Национальные рекомендации по минеральным и костным нарушениям при хронической болезни почек Российского диализного общества (май 2010 г.). Нефрология и диализ. 2011. 13(1): 33-51.</mixed-citation><mixed-citation xml:lang="en">Ермоленко В.М., Волгина Г.В., Добронравов В.А. и др. Национальные рекомендации по минеральным и костным нарушениям при хронической болезни почек Российского диализного общества (май 2010 г.). Нефрология и диализ. 2011. 13(1): 33-51.</mixed-citation></citation-alternatives></ref><ref id="cit4"><label>4</label><citation-alternatives><mixed-citation xml:lang="ru">Земченков А.Ю., Герасимчук Р.П., Земченков Г.А. Коррекция параметров минеральных и костных нарушений при ХБП у диализных пациентов в условиях работы в системе обязательного медицинского страхования. Нефрология и диализ. 2012. 14(4): 235-241.</mixed-citation><mixed-citation xml:lang="en">Земченков А.Ю., Герасимчук Р.П., Земченков Г.А. Коррекция параметров минеральных и костных нарушений при ХБП у диализных пациентов в условиях работы в системе обязательного медицинского страхования. Нефрология и диализ. 2012. 14(4): 235-241.</mixed-citation></citation-alternatives></ref><ref id="cit5"><label>5</label><citation-alternatives><mixed-citation xml:lang="ru">de Barros Gueiros JE, Chammas MC, Gerhard R et al. Percutaneous ethanol (PEIT) and calcitrol (PCIT) injection therapy are ineffective in treating severe secondary hyperparathyroidism. Nephrol. Dial. Transplant. 2004. 19(3): 657-663.</mixed-citation><mixed-citation xml:lang="en">de Barros Gueiros JE, Chammas MC, Gerhard R et al. Percutaneous ethanol (PEIT) and calcitrol (PCIT) injection therapy are ineffective in treating severe secondary hyperparathyroidism. Nephrol. Dial. Transplant. 2004. 19(3): 657-663.</mixed-citation></citation-alternatives></ref><ref id="cit6"><label>6</label><citation-alternatives><mixed-citation xml:lang="ru">Chertow G.M., Block G.A., Correa-Rotter R. et al. The EVOLVE Trial Investigators. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis; Supplement.N. Engl. J. Med. 2012. 367(26): 2482-94.</mixed-citation><mixed-citation xml:lang="en">Chertow G.M., Block G.A., Correa-Rotter R. et al. The EVOLVE Trial Investigators. Effect of cinacalcet on cardiovascular disease in patients undergoing dialysis; Supplement.N. Engl. J. Med. 2012. 367(26): 2482-94.</mixed-citation></citation-alternatives></ref><ref id="cit7"><label>7</label><citation-alternatives><mixed-citation xml:lang="ru">Douthat WG, Chiurchiu CR, Massari PU. New options for the management of hyperparathyroidism after renal transplantation. World J.Transplant. 2012. 2(3): 41-45.</mixed-citation><mixed-citation xml:lang="en">Douthat WG, Chiurchiu CR, Massari PU. New options for the management of hyperparathyroidism after renal transplantation. World J.Transplant. 2012. 2(3): 41-45.</mixed-citation></citation-alternatives></ref><ref id="cit8"><label>8</label><citation-alternatives><mixed-citation xml:lang="ru">Douthat WG, Orozco SE, de Arteaga J, Massari PU. Treatment of refractory secondary hyperparathyroidism with ethanol injection: The importance of glandular volume. Kidney Int. 2003. Suppl. 85: S101-S104.</mixed-citation><mixed-citation xml:lang="en">Douthat WG, Orozco SE, de Arteaga J, Massari PU. Treatment of refractory secondary hyperparathyroidism with ethanol injection: The importance of glandular volume. Kidney Int. 2003. Suppl. 85: S101-S104.</mixed-citation></citation-alternatives></ref><ref id="cit9"><label>9</label><citation-alternatives><mixed-citation xml:lang="ru">Fletcher S, Kanagasundaram NS, Rayner HC et al. Assessment of ultrasound guided percutaneous ethanol injection and parathyroidectomy in patients with tertiary hyperparathyroidism. Nephrol. Dial. Transplant. 1998. 13(12): 1311-1317.</mixed-citation><mixed-citation xml:lang="en">Fletcher S, Kanagasundaram NS, Rayner HC et al. Assessment of ultrasound guided percutaneous ethanol injection and parathyroidectomy in patients with tertiary hyperparathyroidism. Nephrol. Dial. Transplant. 1998. 13(12): 1311-1317.</mixed-citation></citation-alternatives></ref><ref id="cit10"><label>10</label><citation-alternatives><mixed-citation xml:lang="ru">Giangrande A, Cantù P, Solbiati L et al. Ultrasonically guided fine-needle alcohol injection as an adjunct to medical treatment in secondary hyperparathyroidism. Proc. Eur. Dial. Transplant. Eur. Ren. Assoc. 1985. 21: 895-901.</mixed-citation><mixed-citation xml:lang="en">Giangrande A, Cantù P, Solbiati L et al. Ultrasonically guided fine-needle alcohol injection as an adjunct to medical treatment in secondary hyperparathyroidism. Proc. Eur. Dial. Transplant. Eur. Ren. Assoc. 1985. 21: 895-901.</mixed-citation></citation-alternatives></ref><ref id="cit11"><label>11</label><citation-alternatives><mixed-citation xml:lang="ru">Giangrande A, Catiglioni A, Solbiati, L, Allaria P.Ultrasound-guided percutaneous fine-needle ethanol injection into parathyroid glands in secondary hyperparathyroidism. Nephrol. Dial. Transplant. 1992. 7(5): 412-421.</mixed-citation><mixed-citation xml:lang="en">Giangrande A, Catiglioni A, Solbiati, L, Allaria P.Ultrasound-guided percutaneous fine-needle ethanol injection into parathyroid glands in secondary hyperparathyroidism. Nephrol. Dial. Transplant. 1992. 7(5): 412-421.</mixed-citation></citation-alternatives></ref><ref id="cit12"><label>12</label><citation-alternatives><mixed-citation xml:lang="ru">Henry J.F., Sebag F., Cherenko M. et al. Endoscopic parathyroidectomy: why and when? World J. Surg. 2008. 32(11):2509-15.</mixed-citation><mixed-citation xml:lang="en">Henry J.F., Sebag F., Cherenko M. et al. Endoscopic parathyroidectomy: why and when? World J. Surg. 2008. 32(11):2509-15.</mixed-citation></citation-alternatives></ref><ref id="cit13"><label>13</label><citation-alternatives><mixed-citation xml:lang="ru">Tentori F, Wang M, Bieber BA et al. Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: The DOPPS study. Clin J Am Soc Nephrol. 2015 Jan 7. 10(1): 98-109.</mixed-citation><mixed-citation xml:lang="en">Tentori F, Wang M, Bieber BA et al. Recent changes in therapeutic approaches and association with outcomes among patients with secondary hyperparathyroidism on chronic hemodialysis: The DOPPS study. Clin J Am Soc Nephrol. 2015 Jan 7. 10(1): 98-109.</mixed-citation></citation-alternatives></ref><ref id="cit14"><label>14</label><citation-alternatives><mixed-citation xml:lang="ru">Kalantar-Zadeh K., Kuwae N., Regidor D.L. et al. Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients. Kidney Int. 2006. 70(4): 771-800.</mixed-citation><mixed-citation xml:lang="en">Kalantar-Zadeh K., Kuwae N., Regidor D.L. et al. Survival predictability of time-varying indicators of bone disease in maintenance hemodialysis patients. Kidney Int. 2006. 70(4): 771-800.</mixed-citation></citation-alternatives></ref><ref id="cit15"><label>15</label><citation-alternatives><mixed-citation xml:lang="ru">Koiwa F., Kakuta T., Tanaka R. et al. Efficacy of percutaneous ethanol injection therapy (PEIT) is related to the number of parathyroid glands in hemodialysis patients with secondary hyperparathyroidism. Nephrol. Dial. Transplant. 2007. 22(2):522-528.</mixed-citation><mixed-citation xml:lang="en">Koiwa F., Kakuta T., Tanaka R. et al. Efficacy of percutaneous ethanol injection therapy (PEIT) is related to the number of parathyroid glands in hemodialysis patients with secondary hyperparathyroidism. Nephrol. Dial. Transplant. 2007. 22(2):522-528.</mixed-citation></citation-alternatives></ref><ref id="cit16"><label>16</label><citation-alternatives><mixed-citation xml:lang="ru">Miccoli P., Bendinelli C., Vignali E. et al. Endoscopic parathyroidectomy: Report of an initial experience. Surgery. 1998. 124(6): 1077-1080.</mixed-citation><mixed-citation xml:lang="en">Miccoli P., Bendinelli C., Vignali E. et al. Endoscopic parathyroidectomy: Report of an initial experience. Surgery. 1998. 124(6): 1077-1080.</mixed-citation></citation-alternatives></ref><ref id="cit17"><label>17</label><citation-alternatives><mixed-citation xml:lang="ru">Onoda N., Kurihara S., Sakurai Y. et al. Evaluation of blood supply to the parathyroid glands in secondary hyperparathyroidism compared with histopathology. Nephrol. Dial. Transplant. 2003. Suppl. 3: iii34-iii37.</mixed-citation><mixed-citation xml:lang="en">Onoda N., Kurihara S., Sakurai Y. et al. Evaluation of blood supply to the parathyroid glands in secondary hyperparathyroidism compared with histopathology. Nephrol. Dial. Transplant. 2003. Suppl. 3: iii34-iii37.</mixed-citation></citation-alternatives></ref><ref id="cit18"><label>18</label><citation-alternatives><mixed-citation xml:lang="ru">Onoda N., Fukagawa M., Tominaga Y. et al. New clinical guidelines for selective direct injection therapy of the parathyroid glands in chronic dialysis patients. NDT Plus. 2008. Suppl. 3:26-28.</mixed-citation><mixed-citation xml:lang="en">Onoda N., Fukagawa M., Tominaga Y. et al. New clinical guidelines for selective direct injection therapy of the parathyroid glands in chronic dialysis patients. NDT Plus. 2008. Suppl. 3:26-28.</mixed-citation></citation-alternatives></ref><ref id="cit19"><label>19</label><citation-alternatives><mixed-citation xml:lang="ru">Tanaka R., Kakuta T., Koiwa F. et al. Long-term prognosis of parathyroid function in chronic dialysis patients after PEIT - a single-centre trial. NDT Plus. 2008. Suppl. 3: 29-34.</mixed-citation><mixed-citation xml:lang="en">Tanaka R., Kakuta T., Koiwa F. et al. Long-term prognosis of parathyroid function in chronic dialysis patients after PEIT - a single-centre trial. NDT Plus. 2008. Suppl. 3: 29-34.</mixed-citation></citation-alternatives></ref><ref id="cit20"><label>20</label><citation-alternatives><mixed-citation xml:lang="ru">Tominaga Y., Katayama A., Sato T. et al. Re-operation is frequently required when parathyroid glands remain after initial parathyroidectomy for advanced secondary hyperparathyroidism in uraemic patients. Nephrol. Dial. Transplant. 2003. Suppl. 3: iii65-70.</mixed-citation><mixed-citation xml:lang="en">Tominaga Y., Katayama A., Sato T. et al. Re-operation is frequently required when parathyroid glands remain after initial parathyroidectomy for advanced secondary hyperparathyroidism in uraemic patients. Nephrol. Dial. Transplant. 2003. Suppl. 3: iii65-70.</mixed-citation></citation-alternatives></ref><ref id="cit21"><label>21</label><citation-alternatives><mixed-citation xml:lang="ru">Shiizaki K., Negi Sh., Hatamura I. et al. Biochemical and Cellular Effects of Direct Maxacalcitol Injection into Parathyroid Gland in Uremic Rats. J. Am. Soc. Nephrol. 2005. 16(1): 97-108.</mixed-citation><mixed-citation xml:lang="en">Shiizaki K., Negi Sh., Hatamura I. et al. Biochemical and Cellular Effects of Direct Maxacalcitol Injection into Parathyroid Gland in Uremic Rats. J. Am. Soc. Nephrol. 2005. 16(1): 97-108.</mixed-citation></citation-alternatives></ref><ref id="cit22"><label>22</label><citation-alternatives><mixed-citation xml:lang="ru">Shiizaki K., Negi Sh., Hatamura I. et al. Direct vitamin D injection induces apoptosis of parathyroid cells. Kidney Int. 2006. Suppl. 70: S12-S15.</mixed-citation><mixed-citation xml:lang="en">Shiizaki K., Negi Sh., Hatamura I. et al. Direct vitamin D injection induces apoptosis of parathyroid cells. Kidney Int. 2006. Suppl. 70: S12-S15.</mixed-citation></citation-alternatives></ref></ref-list><fn-group><fn fn-type="conflict"><p>The authors declare that there are no conflicts of interest present.</p></fn></fn-group></back></article>
