ssmuБюллетень сибирской медициныBulletin of Siberian Medicine1682-03631819-3684Siberian State Medical University, the Ministry of Healthcare of the Russian Federation10.20538/1682-0363-2025-3-14-24ssmu-6156Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИORIGINAL PAPERSВлияние местных инъекций парикальцитола в околощитовидные железы на уровень паратгормона, сосудистую кальцификацию и минеральную плотность костной ткани у пациентов с хронической болезнью почекThe effect of local injections of paricalcitol into the parathyroid glands on parathyroid hormone levels, vascular calcification, and bone mineral density in patients with chronic kidney diseasehttps://orcid.org/0000-0002-0798-1089ЖулинаЕ. М.ZhulinaE. M.

Жулина Елизавета Михайловна – ассистент, кафедра факультетской терапии с курсами эндокринологии и клинической фармакологии, СибГМУ.

634050, Томск, Московский тракт, 2

2 Moskovsky trakt, 634050 Tomsk

elisaveta.zhulina@gmail.comhttps://orcid.org/0009-0004-7680-4272БрыкунМ. В.BrykunM. V.

Брыкун Мария Владимировна – студентка, СибГМУ.

634050, Томск, Московский тракт, 2

2 Moskovsky trakt, 634050 Tomsk

maryabrykun@gmail.comhttps://orcid.org/0000-0001-9011-8720СапринаТ. В.SaprinaT. V.

Саприна Татьяна Владимировна – д-р мед. наук, доцент, профессор кафедры факультетской терапии с курсами эндокринологии и клинической фармакологии, СибГМУ.

634050, Томск, Московский тракт, 2

2 Moskovsky trakt, 634050 Tomsk

tanja.v.saprina@mail.ruhttps://orcid.org/0000-0002-0424-4825ВорожцоваИ. Н.VorojcovaI. N.

Ворожцова Ирина Николаевна – д-р мед. наук, профессор, профессор кафедры факультетской терапии с курсами эндокринологии и клинической фармакологии, СибГМУ.

634050, Томск, Московский тракт, 2

2 Moskovsky trakt, 634050 Tomsk

vorozhcova.in@ssmu.ruhttps://orcid.org/0000-0002-9892-2825ЦхайВ. Ф.TskhayV. F.

Цхай Валентина Фёдоровна – д-р мед. наук, профессор, профессор кафедры хирургических болезней с курсом травматологии и ортопедии, СибГМУ.

634050, Томск, Московский тракт, 2

2 Moskovsky trakt, 634050 Tomsk

tskhay.vf@ssmu.ruhttps://orcid.org/0000-0002-4164-6823КомковаТ. Б.KomkovaT. B.

Комкова Татьяна Борисовна – д-р мед. наук, профессор, зав. кафедрой хирургических болезней с курсом травматологии и ортопедии, СибГМУ.

634050, Томск, Московский тракт, 2

2 Moskovsky trakt, 634050 Tomsk

komkova.tb@ssmu.ruСибирский государственный медицинский университет (СибГМУ)РоссияSiberian State Medical University (SibSMU)Russian Federation2025151020252431424Copyright © Жулина Е.М., Брыкун М.В., Саприна Т.В., Ворожцова И.Н., Цхай В.Ф., Комкова Т.Б., 20252025Жулина Е.М., Брыкун М.В., Саприна Т.В., Ворожцова И.Н., Цхай В.Ф., Комкова Т.Б.Zhulina E.M., Brykun M.V., Saprina T.V., Vorojcova I.N., Tskhay V.F., Komkova T.B.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://bulletin.ssmu.ru/jour/article/view/6156Цель

Цель. Изучить влияние местных инъекций парикальцитола в околощитовидные железы на костный обмен у пациентов с хронической болезнью почек (ХБП) и вторичным гиперпаратиреозом (ВГПТ) при умеренном повышении уровня паратгормона (ПТГ) (300–600 пг/мл).

Материалы и методы

Материалы и методы. В исследование включены 48 пациентов с терминальной стадией ХБП и ВГПТ с концентрацией паратгормона 300–600 пг/мл. Все пациенты до начала исследования получали стандартное медикаментозное лечение, включающее коррекцию гиперфосфатемии, гипокальциемии и нарушения кальциево-фосфорного обмена. В основную группу (n = 14) вошли пациенты, которым было технически возможно проведение инъекций парикальцитола под ультразвуковым контролем в околощитовидные железы. Оценивались динамика уровня ПТГ, кальцификация сосудов, минеральная плотность костной ткани, уровни ПТГ, b-CrossLaps и FGF23.

Результаты

Результаты. Многомерный логистический регрессионный анализ показал, что остеопороз и сосудистая кальцификация достоверно связаны с возрастом, уровнем ПТГ, длительностью диализа, индексом коморбидности, b-CrossLaps и FGF23. Пороговые значения возраста пациента и ПТГ составили 33 года и 301 пг/мл для развития остеопороза и 29 лет и 301 пг/мл – для сосудистой кальцификации. Корреляционный анализ выявил статистически значимую связь между FGF23 и продолжительностью диализной терапии, b-CrossLaps и уровнем ПТГ, а также между FGF23 и b-CrossLaps. Индекс коморбидности также увеличивался с возрастом и уровнем ПТГ. Через 3 и 6 мес лечения уровень ПТГ значительно снизился, а объем околощитовидных желез остался без изменений. После инъекций не наблюдалось серьезных осложнений, а кратковременная местная болезненность отмечалась только у 8 (57%) пациентов.

Заключение

Заключение. Инъекции парикальцитола в околощитовидные железы под ультразвуковым контролем способствуют снижению уровня ПТГ, улучшению показателей ремоделирования костной ткани и создают предпосылки для предотвращения сердечно-сосудистых осложнений, что требует дальнейшего изучения в рамках более масштабных исследований.

Aim

Aim. To study the effects of local paricalcitol injections into the parathyroid glands on bone turnover in patients with chronic kidney disease (CKD) and secondary hyperparathyroidism (SHPT) with moderately elevated parathyroid hormone (PTH) levels (300–600 pg/mL).

Materials and methods

Materials and methods. The study included 48 patients with end-stage CKD and SHPT with PTH levels of 300–600 pg/mL. All patients received standard medical therapy before the study, including correction of hyperphosphatemia, hypocalcemia, and disorders of calcium-phosphorus metabolism. The main group (n = 14) comprised patients for whom ultrasound-guided paricalcitol injections into the parathyroid glands were technically feasible. The dynamics of PTH levels, vascular calcification, bone mineral density (BMD), and levels of PTH, b-CrossLaps, and FGF23 were assessed.

Results

Results. Multivariate logistic regression analysis demonstrated that osteoporosis and vascular calcification were significantly associated with age, PTH levels, dialysis duration, comorbidity index, b-CrossLaps, and FGF23. Threshold values for age and PTH were 33 years and 301 pg/mL for the development of osteoporosis and 29 years and 301 pg/mL for vascular calcification. Correlation analysis revealed a statistically significant relationship between FGF23 and dialysis duration, b-CrossLaps and PTH levels, as well as between FGF23 and b-CrossLaps. The comorbidity index also increased with age and PTH levels. After 3 and 6 months of treatment, PTH levels significantly decreased, while the volume of the parathyroid glands remained unchanged. No serious complications were observed after the injections, and transient local pain was reported in only 8 (57%) patients.

Conclusion

Conclusion. Ultrasound-guided paricalcitol injections into the parathyroid glands contribute to reducing PTH levels, improving bone remodeling parameters, and creating conditions for preventing cardiovascular complications. These findings require further investigation in larger-scale studies.

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The authors declare that there are no conflicts of interest present.