肩关节透析相关性淀粉样变的临床特点与磁共振诊断  

Art.Humeri with Dialysis-related Amyloidosis of Clinical Features and MRI Diagnosis

作　　者：刘一李[1] 何承荣[1] 杨晓玲[1] 吴光任[2] 陈权[1] 钟洁莲[1] 徐榆萍[1] 

机构地区：[1]广东省东莞市虎门医院内科,523911 [2]广东省东莞市虎门医院放射科,523911

出　　处：《岭南急诊医学杂志》2009年第5期361-363,共3页Lingnan Journal of Emergency Medicine

摘　　要：目的:总结肩关节透析相关性淀粉样变(DRA)的临床特点和磁共振(MRI)的诊断价值。方法:选取具有肩关节疼痛、僵硬、肿胀等症状并排除继发性甲状旁腺功能亢进的维持性血透(MHD)患者12例为症状组,无症状MHD患者12例为对照组。比较两组的年龄、透析时间、β2微球蛋白(β2-M)。MRI检查双侧肩关节,测量岗上肌肌腱与肩胛下肌肌腱厚度,观察骨质破坏情况。结果:症状组年龄、透析时间、血清β2-M均显著高于对照组(P<0.05);症状组岗上肌肌腱和肩胛下肌肌腱增厚显著大于对照组(P<0.01)。症状组MRI检查阳性100%,对照组25%;症状组7例骨质破坏,对照组发现1例轻微骨质破坏。结论:年龄大、透析时间长的患者更易表现出DRA临床症状,症状轻重与关节受损程度有关。MRI可有效发现DRA的征象,无症状者的肩关节也有MRI阳性发现,提示MRI对DRA的早期诊断有肯定价值。Objective:To summarize the clinical features of the art.humeri with dialysis-related anglosis (DRA) and the diagnostic value of magnetic resonance (MRI).Methods:12 patients with art.humeri pain,stiffness,swelling clinical syndrome as the symptom group,which were exclused the secondary hyperparathyroidism with maintenance hemodialysis (MHD),and 12 patients who has no clinical syndrome as the control group.Comparing the age,dialysis time,β2-microglobulin (β2-M) of the two groups.Bilateral art.humeri was examined and tendon thickness of the m. supraspinatus and the m.subscapularis were measured,and bone damage observed in the MRI.Results:The age, dialysis duration,serum β2-M of the symptoms group were significantly higher than those in the control group (P< 0.05).The tendon thickness of the m.supraspinatus and the m.subscapularis were significantly thicker in symptoms group than those in the control group(P<0.01).The MRI-positive rate of the symptom group was 100%,and 25% of the control group accordingly.The symptoms group had seven cases of bone destruction,one case had mild bone damage in the control group.Conclusion:The older、 the longer of dialysis time can more easier to have DRA clinical symptoms,the severity of symptoms has a relation with the degree of articulation damage.MRI can effectively find the signs of DRA.MRI positive signal was also found in the cases who have no clinical syndromes.It suggests that MRI has sure value for early diagnosis of DRA.

关 键 词：肩关节疼痛 透析相关性淀粉样变 临床特点 磁共振诊断 MRI检查 无症状 对照组 透析时间 骨质破坏 继发性甲状旁腺功能亢进 肩胛下肌 肌腱 患者 DRA 维持性血透 诊断价值 早期诊断 阳性 微球蛋白 破坏情况 

分 类 号：R597.2[医药卫生—内科学] R445.2[医药卫生—临床医学]