尿毒症肿瘤样钙质沉着症10例临床分析  

Clinical characteristics of 10 patients with uremic tumoral calcinosis

作　　者：熊敏 王晶 李旭东 余永武 张凌[4] Xiong Min;Wang Jing;Li Xudong;Yu Yongwu;Zhang Ling(Department of Nephrology,Beijing Chuiyangliu Hospital,Beijing 100022,China;Sunhe Community Health Service Center,Beijing 100015,China;Department of Nephrology,Beijing Liangxiang Hospital,Beijing 102401,China;Department of Nephrology,China-Japan Friendship Hospital,Beijing 100029,China)

机构地区：[1]北京市垂杨柳医院肾内科,100022 [2]北京孙河社区卫生服务中心,100015 [3]北京良乡医院肾内科,102401 [4]中日友好医院肾内科,北京100029

出　　处：《中华内科杂志》2020年第11期860-865,共6页Chinese Journal of Internal Medicine

基　　金：吴阶平医学基金会临床科研专项资助基金(320.6750.18110)。

摘　　要：目的分析10例尿毒症肿瘤样钙质沉着症(UTC)患者的临床资料,提高临床医生对其的认识和诊治水平。方法收集2013年3月至2019年2月中日友好医院肾内科6例和北京市垂杨柳医院肾内科4例UTC患者,分析总结其临床表现、实验室检查、影像学检查、病理资料、治疗及随访预后。结果10例UTC患者中,男性4例,女性6例,年龄(39.90±8.57)岁,均为规律血液透析患者,透析龄(5.90±2.57)年。3例表现为一侧关节单发病灶,7例为肩关节、髋关节、肘关节等大关节周围多发病灶。2例血钙升高>2.75 mmol/L。10例患者不同程度血磷升高[2.22(1.94,2.44)mmol/L]。10例患者全段甲状旁腺激素(iPTH)均升高,其中9例iPTH明显升高[1348.0(854.8,1800.0)ng/L],1例iPTH轻度升高(92.4 ng/L)。10例患者超敏C反应蛋白均升高[35.81(17.60,74.20)mg/L]。治疗前影像学表现为关节附近软组织内大量不规则团块状钙化影,边缘清晰,周围骨质未见明显吸收、破坏。9例合并严重继发性甲状旁腺功能亢进(SHPT),行甲状旁腺外科治疗,共切除32枚甲状旁腺,病理结果显示弥漫性增生7枚,弥漫性/结节状增生11枚,结节状增生14枚,每例患者有1枚以上甲状旁腺为结节状增生。1例未合并严重SHPT,予内科保守治疗。术后随访17(8~84)个月。影像学显示,行甲状旁腺外科治疗的9例患者包块均有不同程度缩小或消失,1例内科综合治疗者包块变化不明显。结论UTC是规律血液透析患者少见的并发症,通常与合并严重SHPT相关,积极的甲状旁腺外科治疗可改善预后。Objective To analyze the clinical characteristics of patients with uremic tumoral calcinosis(UTC).Methods A total of 10 patients with UTC were enrolled in this study,who were admitted in the Department of Nephrology,China-Japan Friendship Hospital and Beijing Chuiyangliu Hospital from March 2013 to February 2019.Results The average age of 4 male and 6 female patients on regular hemodialysis was(39.90±8.57)years.The average dialysis duration was(5.90±2.57)years.Three patients presented as single lesion of one joint,the other 7 patients as involvement of multiple large joints.Serum calcium was elevated in 2 patients,both over 2.75 mmol/L.Serum hyperphosphatemia was seen in all patients with average level 2.22(1.94,2.44)mmol/L.Serum intact parathyroid hormone(iPTH)was remarkably increased in 9 patients with average level 1348.0(854.8,1800.0)ng/L,while only 1 patient reported slight elevation(92.4 ng/L).High-sensitivity C-reactive protein increased in all 10 patients with average 35.81(17.60,74.20)mg/L.The imaging findings before treatment suggested that a large number of irregular masses of calcification shadows deposited in the soft tissue adjacent to the joints.The outlines of calcification were clear without significant bone absorption.Nine patients with severe secondary hyperparathyroidism(SHPT)were treated with parathyroidectomy,resulting in lesions diminishing or even disappearing.A total of 32 parathyroid glands were resected,and pathological results showed that 7 parathyroids were diffuse hyperplasia,11 as diffuse/nodular hyperplasia,the rest 14 as nodular hyperplasia.At least one hyperplastic parathyroid gland was seen in each patient.Only 1 patient received medical therapy yet no obvious improvement was observed.Conclusion UTC is a rare complication in patients on regular hemodialysis,which is usually associated with severe SHPT.Parathyroid surgery may improve the clinical outcome.

关 键 词：尿毒症 血液透析 肿瘤样钙质沉着症 甲状旁腺功能亢进 继发性 

分 类 号：R692.5[医药卫生—泌尿科学]