慢性肾脏病继发甲状旁腺功能亢进与高血压的管理新进展

Relationship between Secondary Hyperparathyroidism and Hypertension in Chronic Kidney Disease

摘要: 继发性甲状旁腺功能亢进(Secondary Hyperparathyroidism, SHPT)是慢性肾脏病(Chronic Kidney Disease, CKD)常见且严重的并发症之一，其在维持性血液透析患者中的发病率呈逐年上升趋势。SHPT以甲状旁腺激素(Parathyroid hormone, PTH)水平升高及钙磷代谢紊乱为特征，可累及皮肤、骨骼及心脑血管等多个系统。高血压作为CKD常见的心血管危险因素，严重影响着患者的预后，并导致死亡率增加。SHPT与高血压在CKD进程中常并存且相互加剧，构成复杂的临床挑战。传统上，两者的关联多归因于PTH驱动的钙磷代谢紊乱与血管钙化。然而，新兴证据表明，钙敏感受体(Calcium-Sensing Receptor, CaSR)下调、成纤维细胞生长因子受体-23 (Fibroblast Growth Factor-23, FGF-23)升高及Klotho蛋白表达减少在其中的作用远超既往认知，不仅是SHPT的核心机制，更是导致高血压与心血管损害的直接路径。本文将在传统视角的基础上，重新审视SHPT的发病机制、SHPT与高血压的病理生理关联，以及SHPT治疗如何打破与高血压的恶性循环。旨在阐明二者间的相互作用，深化对SHPT与高血压关系的认识，为临床诊疗提供参考。

Abstract: Secondary Hyperparathyroidism (SHPT) is one of the common and serious complications of Chronic Kidney Disease (CKD), and its incidence rate has been increasing year by year among maintenance hemodialysis patients. Characterized by elevated levels of Parathyroid Hormone (PTH) and calcium-phosphorus metabolism disorders, SHPT can involve multiple systems such as the skin, bones, and cardiovascular and cerebrovascular systems. As a common cardiovascular risk factor in CKD, hypertension seriously affects patients’ prognosis and leads to an increase in mortality. SHPT and hypertension often coexist and mutually exacerbate each other during the progression of CKD, posing a complex clinical challenge. Traditionally, the association between the two has been mostly attributed to PTH-driven calcium-phosphorus metabolism disorders and vascular calcification. However, emerging evidence indicates that the downregulation of the Calcium-Sensing Receptor (CaSR), upregulation of Fibroblast Growth Factor-23 (FGF-23), and decreased expression of Klotho protein play a role far beyond previous understanding in this process—they are not only the core mechanisms of SHPT but also direct pathways leading to hypertension and cardiovascular damage. Based on traditional perspectives, this article will re-examine the pathogenesis of SHPT, the pathophysiological association between SHPT and hypertension, and how SHPT treatment breaks the vicious cycle with hypertension. It aims to clarify the interaction between the two, deepen the understanding of the relationship between SHPT and hypertension, and provide a reference for clinical diagnosis and treatment.