血液透析患者合并糖尿病肌梗死一例及文献复习  

Diabetic muscle infarction in hemodialysis: a case report and literature review

作　　者：伍彬 尚伟锋 位红兰 李维[2] 董莉萍[2] 董骏武[2] 

机构地区：[1]江汉大学医学院,武汉430000 [2]华中科技大学同济医学院附属武汉市普爱医院肾病风湿科

出　　处：《临床肾脏病杂志》2017年第10期598-601,共4页Journal Of Clinical Nephrology

基　　金：湖北省自然科学基金面上项目(No.2014CFC1047);武汉市卫生计生委科研项目(No.WG15A02);武汉市科技局科研项目(No.201260523197-2)

摘　　要：目的探讨血液透析合并糖尿病肌梗死患者的发病特点,提高临床医师对该疾病的认识。方法对华中科技大学同济医学院附属武汉市普爱医院一例血液透析合并糖尿病肌梗死患者的临床资料进行回顾性分析,并对相关文献进行复习,分析该特殊人群的发病特点,探讨可能的发病机制和治疗手段。结果本例患者,男性,48岁,因糖尿病肾病、慢性肾衰竭行血液透析治疗,10 d前突发左侧小腿疼痛、肿胀,无全身感染症状及外伤史,入院实验室结果提示血沉、C反应蛋白、降钙素原、肌酸激酶等指标上升,左小腿MRI显示T2加权像异常高信号,双下肢动静脉彩超提示双下肢动脉内中增厚并粥样硬化斑形成,经详细鉴别诊断,最终确诊为血液透析合并糖尿病肌梗死,并给予严格控制血糖、改善循环、局部消炎止痛、充分血液透析治疗后,患者症状好转出院。结论糖尿病肌梗死是糖尿病的一种罕见的微血管并发症,血液透析合并糖尿病肌梗死的发病率更低,在血液透析合并长期血糖控制欠佳的糖尿病患者中出现非外伤性肌肉疼痛时需考虑该疾病,该病的早期识别与诊断,并给予控制血糖、止痛、改善循环等合理对症治疗,对改善患者预后意义较大。另外,加强血液透析治疗可有效改善患者症状,在治疗中有一定的效果,但需要进一步的临床研究证实。Objective To investigate the clinical characteristic of diabetic muscle infarction（ DMI）in hemodialysis and to improve the understanding of this disease. Methods The clinical data of one case of DMI in hemodialysis in our hospital were retrospectively analyzed,and the related literatures were reviewed to examine the clinical features,treatment,and prognosis of this condition. Results A 48-year-old man with renal failure due to diabetes who was given regular hemodialysis was admitted to our hospital. He had a sudden onset of painful swelling of his left gastrocnemius and soleus 10 days ago,with no systemic infection and trauma. Laboratory values included a significantly elevated ESR,CRP,PCT and CK etc. High signal lesion appeared on T2-weighted MRI. The double lower limb artery intima-media thickness and atherosclerotic plaque were shown on lower limb color sonography. After differential diagnosis work up,the patient was diagnosed as hemodialysis complicated with DMI. The patient was treated with intensive control of his blood glucose level and circulation improvement,anti-inflammatory and sufficient hemodialysis treatments,and his condition was improved at discharge. Conclusions DMI is a rare microangiopathic complication of diabetes,and the incidence of DMI in hemodialysis patients is lower. Physicians should have a high index of suspicion for DMI in hemodialysis patients with poorly controlled diabetic mellitus presenting with sudden onset,nontraumatic muscle pain. The early recognition and correct diagnosis of this complication,and reasonable treatments such as control of blood glucose level,analgesia,and improvement of circulation,are of great significance to improve the prognosis. In addition,we found that intensive hemodialysis treatment can effectively improve symptoms,but further clinical studies are needed to confirm.

关 键 词：糖尿病 糖尿病肌梗死 血液透析 

分 类 号：R587.2[医药卫生—内分泌] R692[医药卫生—内科学]