vestimИзвестия Национальной академии наук Беларуси. Серия медицинских наукProceedings of the National Academy of Sciences of Belarus, Medical series1814-60232524-2350The Republican Unitary Enterprise Publishing House "Belaruskaya Navuka"10.29235/1814-6023-2021-18-2-186-195vestim-760Research ArticleКЛИНИЧЕСКАЯ И ЭКСПЕРИМЕНТАЛЬНАЯ МЕДИЦИНАCLINICAL AND EXPERIMENTAL MEDICINEОпределение референтного интервала паратгормона у пациентов с различными стадиями хронической болезни почекDetermination of the parathyroid hormone reference interval in patients with different stages of the chronic kidney diseaseКарловичН. В.KarlovichN. V.

Карлович Наталия Викторовна ‒ канд. мед. наук, главный врач

ул. Макаенка, 17, 220017, г. Минск

Natalia V. Karlovich ‒ Ph. D. (Med.), Chief Doctor

17, Makayenka Str., 220017, Minsk 

natkarlovich@gmail.comСпиридоноваО. С.SpiridonovaO. S.

Спиридонова Ольга Сергеевна ‒ мл. науч. сотрудник

пр. Дзержинского, 83, 220116, г. Минск 

Olga S. Spiridonova ‒ Junior Researcher

83, Dzerzhinski Ave., 220116, Minsk 

spiry87@mail.ruСазоноваЕ. Г.SazonovaE. G.

Сазонова Елена Геннадьевна ‒ врач-эндокринолог

ул. Макаенка, 17, 220017, г. Минск

Elena G. Sazonova ‒ Endocrinologist

17, Makayenka Str., 220017, Minsk 

trofi_elena@mail.ruМохортТ. В.MokhortT. V.

Мохорт Татьяна Вячеславовна ‒ д-р мед. наук, профессор, заведующий кафедрой

пр. Дзержинского, 83, 220116, г. Минск

Tatiana V. Mokhort ‒ D. Sc. (Med.), Professor, Head of the Department

83, Dzerzhinski Ave., 220116, Minsk 

tatsianamokhort@gmail.comРеспубликанский центр медицинской реабилитации и бальнеолеченияRepublican Center of Medical Rehabilitation and BalneotherapyБелорусский государственный медицинский университетBelarusian State Medical University202104062021182186195Copyright © Карлович Н.В., Спиридонова О.С., Сазонова Е.Г., Мохорт Т.В., 20212021Карлович Н.В., Спиридонова О.С., Сазонова Е.Г., Мохорт Т.В.Karlovich N.V., Spiridonova O.S., Sazonova E.G., Mokhort T.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestimed.belnauka.by/jour/article/view/760

Вторичный гиперпаратиреоз (ВГПТ) является одним из наиболее клинически значимых осложнений хронической болезни почек (ХБП), обусловленных ассоциированными минеральными, костными нарушениями, метастатической кальцификацией.Проанализированы показатели минерально-костного обмена у 635 пациентов с различными стадиями ХБП и у 50 лиц группы контроля при помощи нейросетевого алгоритма и математической технологии BootStrаp, что позволило определить целевые интервалы паратгормона (ПТГ) для каждой стадии у пациентов с ХБП, соответствующие оптимальным показателям минеральной плотности и обмена костной ткани, с целью улучшения выживаемости данной категории пациентов. Установлено, что у пациентов с ХБП верхний предел референтного интервала уровня ПТГ при скорости клубочковой фильтрации (СКФ) более 35 мл/мин совпадает с общепопуляционным, при СКФ, равной 15‒35 мл/мин, составляет 185 пг/мл (в 3 раза превышает общепопуляционный), а при СКФ менее 15 мл/мин ‒ 500 пг/мл (в 7,5 раза превышает общепопуляционный). У диализных пациентов при уровне ПТГ 500‒1500 пг/мл возможно сохранение удовлетворительных параметров костного обмена, а уровень ПТГ более 1500 пг/мл указывает на экстремальный риск развития осложнений ВГПТ.

Secondary hyperparathyroidism (SHPT) is one of the most clinically significant complications of chronic kidney disease (CKD) due to associated mineral, bone disorders, and metastatic calcification. The indicators of mineral and bone metabolism of 635 patients with different CKD stages and 50 persons of the control group were analyzed using a neural network algorithm and the mathematical technology BootStrаp, which allowed determining the target PTH intervals for each stage in patients with CKD, corresponding to the optimal indicators of mineral density and metabolism bone tissue, in order to improve the survival of this category of patients. It was found that the upper limit of the reference interval of the PTH level in patients with CKD and GFR > 35 ml/min coincides with the general population, in patients with CKD and GFR 15‒35 ml/min it is 185 pg/ml, which is 3 times higher than in the general population, and in patients with CKD and GFR < 15 ml/min it is 500 pg/ml (7.5 times higher than in the general population). In dialysis patients with the PTH level of 500‒1500 pg/ml, it is possible to maintain satisfactory parameters of bone metabolism, and the PTH level of >1500 pg/ml determines the extreme risk of developing severe SHPT complications.

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