继发性甲状旁腺功能亢进症患者维生素D受体和钙敏感受体的免疫组化研究

摘要

Objective To investigate the relationship between the expression of vitamin D receptor (VDR) and calcium-sensing receptor receptor (CaSR) and the proliferative activity in the parathyroid tissue from secondary hyperparathyroidism (SHPT) patients.Methods The numbers of VDR- and CaSR-positive cells after immunohistochemistry staining in the parathyroid tissues of various degrees of SHPT were compared with those in the normal parathyroid tissues.Results Among the 21 proliferation parathyroid glands, one was diagnosed as diffuse hyperplasia (group B), 13 were diagnosed as nodular hyperplasia (group C), and 7 as adenoma hyperplasia (group D).(a) VDR was mostly nuclear localized in cells of normal parathyroid (group A).The expression of VDR in groups A, B, C and D was (78.0 ± 2.5)％, 57.1％, (31.0 ± 6.7)％ and (23.0 ±2.1)％, respectively (P ＜ 0.01 ).The expression level of VDR correlated with the hyperplasia degree of parathyroid glands.(b) CaSR was mostly expressed on cell membrane and in cytoplasm.CaSR expression was reduced in parathyroid samples from SHPT patients (48.0 ± 17.9％), as compared with that in group A (79.0 ± 1.0％, P ＜ 0.01).CaSR expression was 51％, (47.0 ± 9.8)％ and 29.0 ± 10.1％ in group B, C and D, respectively (P ＜0.01).Conclusions (a) The lower expression of VDR and CaSR appears to be the cause of SHPT refractory to the calcitrol pulse therapy.(b) Attempts to increase the expression of the two receptors or to use the agonists of the two receptors may be the new approaches to SHPT therapy.%目的 通过研究维生素D受体(vitamin D receptor,VDR)和钙敏感受体(calciumsensing receptor,CaSR)在继发性甲状旁腺功能亢进症(Secondary hyperparathyroidism,SHPT)患者甲状旁腺组织中的表达,探讨VDR和CaSR与SHPT甲状旁腺组织病理改变的关系.方法 用免疫组化的方法 计数CaSR和VDR阳性细胞,比较其在不同程度SHPT中甲状旁腺组织及正常甲状旁腺组织的阳性表达.结果 VDR阳性细胞表达几乎存在于所有主细胞的细胞核,呈黄褐色,胞膜和胞浆不着色.SHPT组较对照组明显下调,分别为(39.0±19.7)%和(78.0±2.5)%,差异有统计学意义(P<0.01).SHPT弥漫性增生组、结节性增生组和腺瘤样增生组表达分别为57.1%、(31.0±6.7)%和(23.0±2.1)%,差异有统计学意义(P<0.01).CaSR阳性细胞表达主要定位于主细胞的胞膜和胞浆,呈黄褐色.SHPT组较对照组明显下调,分别为(48.0±17.9)%和(79.0±1.0)%,差异有统计学意义(P<0.01).弥漫性增生组、结节性增生组和腺瘤样增生组的CaSR表达分别为51.0%、(47.0±9.8)%和(29.0±10.1)%,差异有统计学意义(P<0.01).结论 VDR和CaSR表达均随甲状旁腺组织增生的程度增高而下调.VDR和CaSR的表达下调可能是活性维生素D治疗无效的病理基础.上调VDR和CaSR表达水平以及进一步激活受体功能是内科治疗SHPT的研究方向.