钙性尿毒症性小动脉病(附3例报告)  

Calciphylaxis:Report of three cases and literature review

作　　者：张凌[1] 董葆[2] 刘莉 杜学海[2] 

机构地区：[1]中日友好医院血液净化中心,北京100029 [2]中日友好医院肾内科,北京100029 [3]成都铁路分局

出　　处：《肾脏病与透析肾移植杂志》2002年第5期427-431,441,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的 :通过 3例钙化防御 (钙性尿毒症性小动脉病 )病例总结 ,介绍钙化防御的诊断、预防及治疗。　方法 :回顾性总结 3例尿毒症继发性甲旁亢并发的钙化防御。　 结果 :例 1在手部、双肘、头部及背部出现网状紫斑及多发性皮下肿块。例 2在脚趾根部出现痛性网状紫斑及皮肤溃疡。例 3表现为足跟部及脚趾痛性网状紫斑和干性坏死。X线照片 3例均显示病变附近软组织钙化或血管钙化。例 1接受甲状旁腺内酒精注射治疗后 ,继发性甲旁亢得到控制 ,皮下肿块及软组织钙化基本消失。例 2应用低钙透析液透析后溃疡面缩小 ,例 2和例 3作了坏死组织切除 ,最后死亡。　 结论 :钙化防御一旦发生 ,预后不良 。Objective:Calciphyaxis in the patients with hemodialysis:Diagnosis,prevention and treatment. Methodology:Calciphyaxis in three uremic hyperparathyroidism patients with hemodialysis were reported retrospectively. Results:Three patients were undergoing hemodialysis due to chronic renal failure and complicated by secondary hyperparathyroidism.All of them had violeceous reticularis on the skin of the lesions.In case 1,multiple subcutaneous nodules on the hands,elbows,head and back were observed.In case 2,painful skin ulceration of the dorsum of the right foot was developed.In case 3,painful tissue necrosis was found on the left heel and later on the right great toe.X ray examination showed the soft tissue calcification or calcification of the vessels adjacent to the lesions.In case 1,multiple subcutaneous nodules and soft tissue calcification disappeared after successful treatment of hyperthyroidism by percutaneous ethanol injection.In case 2,skin ulceration improved after low calcium hemodialysis.In case 2 and 3,amputations were performed and soon two patients were died. Conclusion:Calciphyaxisis a rare but sometimes life threatening disease in patients with maintenance hemodialysis disease.

关 键 词：钙性尿毒症性小动脉病 继发性 甲状旁腺机能亢进症 诊断 预防 治疗 

分 类 号：R692.5[医药卫生—泌尿科学] R582.1[医药卫生—外科学]