透析相关性淀粉样变的临床报道

The clinical report of dialysis-related amyloidosis

目的 探讨长期血液透析患者透析相关淀粉样变(Dialysisrelatedamyloidosis,DRA)的临床及诊治方法。方法 对10年以上长期血液透析患者30例进行B超(小器官高频浅表探头)检查,测定肩袖(rotatorcuff,RC)厚度以及观察肩关节周围有无强回声(PE)、X片、部分行CT、MRI检查。结果 长期血液透析患者超过10年以上共30例,均接受B超检查,其中2 5例RC增厚,为(0 .86±0 .12 )mm(正常参考值<0 .8mm) ,占83.3% ,PE阳性者6例,占2 0 .0 % ,膝关节积液者2 0例,占6 6 .6 %。颈部、手、膝关节X线检查14例,可见囊性骨损害者10例占71.4 % ,2例有颈椎间隙变窄占14 .3% ,但经CT检查骨囊性变为10 0 % ,CT和MRI检查发现颈端脊髓呈骨破坏2例占14 .3%。结论 透析相关淀粉样变是长期血液透析患者的致残性严重并发症,B超检查可早期发现DRA的证据,CT及MRI检查有助于发现X线不易显示的脊椎关节DRA(破坏性骨关节病)及骨囊肿,应及早发现和早期治疗,以防止造成不可逆的全身性损害。

Objective To discussing the clinical manifestation, diagnosis and treatment of the dialysis-related amyloidosis (DRA) in the long-term hemodialysis patients. Methods In 30 patients with more than 10 years of hemodialysis treatment, the maximal thickess of the rotator cuff(RC) were measured by Bultrosoumd (BUS) and PE cround the shoulder joint were observed; X-ray, CT and MRI were used in a part of patients. Results All patients were examined with B ultrasound, and in 25 cases (83.3%) the thickness of RC increased with mean value (0.86±0.12)mm (normal<0.8mm). In 6 cases PE were positive (20%). Twenty cases had articular hydrops (66.6%). Fourteen patients' neck, hands and knee joints were examined with X-ray, 10 cases were found with cystic bone lesions (71.4%) and 2 cases complicated with osteoporosis and cervical stenosis (14.3%). However, in the 14 cases checked with CT, all were detected with bone cysts (100%) and 2 cases were found with cervical stenosis when examined with CT and MRI (14.3%). Conclusion DRA is a severe complication for long-term dialysis patients. It can be found by BUS. CT and MRI are helpful for early diagnosis of DRA and bone cysts which is hard to detect with X-ray method. These diseases should be found and treated early to prevent unreversible body lesion.