透析相关性肿瘤样钙化19例诊疗体会

Diagnosis and treatment of 19 cases of dialysis related tumoral calcinosis

目的总结透析相关性肿瘤样钙化又称尿毒症肿瘤样钙化(uremic tumoral calcinosis,UTC)的临床特点、诊断及治疗体会。方法回顾性分析19例UTC病人临床资料,总结其病史、生化指标、影像学表现和诊疗方法。通过比较治疗前后的疼痛、关节活动度、血磷、血钙、甲状旁腺素(parathyroid hormone,PTH)、影像学表现的钙化灶大小,评估治疗效果。结果 19例病人治疗前后疼痛改善,关节活动度增加。血磷、PTH明显下降,差异有统计学意义(P<0.05),血钙更加稳定,影像学检查可见钙化灶减小甚至消失。结论透析相关性肿瘤样钙化病人均具有长期透析病史后出现肿块的特征,根据病史、生化指标和影像学表现,可以减少误诊,治疗主要根据病人综合情况,调整血磷、血钙及PTH等内科综合治疗,必要时手术清除。

Objective Dialysis related tumoral calcinosis, also known as uremic tumoral calcino- sis（UTC） is a rare non-neoplastic disease. This article mainly discusses its clinical features ,diagnosis and treatment. Methods A retrospective analysis was conducted on the date of 19 cases of UTC, including their biochemical indicators, imaging findings, diagnosis and treatment methods. The therapeutic effect was evaluated by comparing the pain, the degree of joint mobility, serum phosphorus, serum calcium, parathy- roid hormone（ PTH）, and the size of the calcification in the image before and after treatment. Results Before and after treatment, the pain of 19 patients was improved and the joint activity was increased. The levels of phosphorus and PTH were significantly decreased, and the difference was statistically significant （ P 〈 0.05 ）. The serum calcium was more stable. The calcification lessened or even disappeared on the imaging examination. Conclusion Dialysis related tumoral calcinosis patients with long-term dialysis af- ter the appearance of mass, according to history, biochemical indicators and imaging findings, can improve the understanding of the disease and reduce misdiagnosis ,the main treatment based on the patient＇s com- prehensive adjustment of blood phosphorus and calcium and PTH and other medical comprehensive treat- ment, if necessary, surgical removal.