我国一个中心透析相关性淀粉样变的发生率和危险因素分析  

The prevalence and risk factors of dialysis-related amyloidosis-data from a Chinese hemodialysis center

作　　者：林跃萍[1] 侯凡凡[1] 杨燕[2] 刘志强[1] 

机构地区：[1]南方医院肾内科,广州510515 [2]南方医院影像中心,广州510515

出　　处：《中华肾脏病杂志》2001年第2期115-118,共4页Chinese Journal of Nephrology

基　　金：国家自然科学基金资助项目(39770349)

摘　　要：目的 了解长期血液透析（ＨＤ）患者透析相关性淀粉样变（ＤＲＡ）的发病率和相关因素。方法 应用高分辨率超声诊断仪对７０例规律ＨＤ患者进行肩关节检查，测定旋转袖（ＲＣ）的最大厚度并观察关节周围有无增强回声（ＥＰ）。以ＲＣ＞０．８ｃｍ和（或）有ＥＰ为诊断ＤＲＡ的阳性标准。同时采用ＥＬＩＳＡ和放射免疫法测定血清晚期糖基化终产物（ＡＧＥ）、β２微球蛋白（β２－ｍ）和甲状旁腺激素（ＰＴＨ）水平。结果 ４２／７０例（６０％）在超声检查下提示有肩关节病变，其阳性率随透析龄延长而增加。右侧肩关节发生率高于左侧。合并肩关节病变组的血清ＡＧＥ水平明显高于无病变组（Ｐ＜０．０５），但两组间血清β２－ｍ和ＰＴＨ水平差异无显著性意义。结论 尽管导致慢性肾衰的病因和年龄分布与国外有很大不同，本组ＤＲＡ的发生率仍高达６０％。ＤＲＡ的发生率与透析时间的长短及血清ＡＧＥ水平明显相关。Objective To investigate the prevalence and risk factors of dialysis-related amyloidosis (DRA). Methods Shoulder ultrasound examination was performed in 70 patients on long-term hemodialysis (HD) by using the high-resolution ultrasound. DRA was diagnosed if ultrasound showed a rotator cuff (RC) > 0. 8cm in thickness and/or presence of an echogenic pad (EP) between the muscle layers of the rotator cuff . Serum levels of advanced glycation end products (AGE), 132-microglobulin ((32-rn) and parathyroid hormone (PTH) were measured at same time. Results The amyloid arthropathy was found in 42 (60 %) of the 70 dialyzed patients. The prevalence of the amyloid arthropathy rose with dialysis duration, and was found more often in right shoulder compared with left one. Serum AGE levels, but not 132-rn levels and diabetic nephropathy , was independent risk factor for DRA. Conclusions The incidence of DRA is up to 60% in our patients with long-term HD. The serum levels of AGE and the duration of HD are related with the occurrence of DRA.

关 键 词：血液透析 糖基化终产物 Β2微球蛋白 淀粉样变 发生率 危险因素 

分 类 号：R459.5[医药卫生—治疗学] R597.2[医药卫生—临床医学]