Homma N, Gejyo F, Kobayashi H, Saito H, Sakai S, Suzuki M, Hirasawa Y, Arakawa M
Department of Medicine (II), Niigata University School of Medicine, Japan.
Nephron. 1992;62(1):6-12. doi: 10.1159/000186986.
Patients on long-term hemodialysis (HD) are known to develop amyloid osteoarthropathy, evidenced as cystic radiolucencies on X-rays of the affected joints. To study the relationship between cystic radiolucencies and amyloid osteoarthropathy in 394 patients, we classified the severity of the cystic radiolucencies seen in the wrist joint on a 4-point scale and evaluated the association between lesion severity (grade) and several parameters. Biopsy was performed in 8 patients with 11 bone cysts of the wrist joint who had been operated for carpal tunnel syndrome. HD for 10 years or longer, age 50 or older and the presence of carpal tunnel syndrome were associated with severe cyst rating. There was no association between lesion grade and serum level of PTH-C, aluminum or beta 2-microglobulin (B2M). Ten of the 11 biopsied bone cysts in 8 patients with carpal tunnel syndrome demonstrated amyloid deposits which reacted with B2M. We conclude that a cystic radiolucency observed in the wrist joint of a patient undergoing HD indicates the deposition of amyloid. The cyst grade provides a useful marker for the severity of amyloid osteoarthropathy in HD patients.
长期血液透析（HD）患者会出现淀粉样骨关节病，在受影响关节的X线片上表现为囊性透光区。为研究394例患者中囊性透光区与淀粉样骨关节病的关系，我们采用4分制对腕关节中所见囊性透光区的严重程度进行分类，并评估病变严重程度（分级）与多个参数之间的关联。对8例因腕管综合征接受手术的腕关节有11个骨囊肿的患者进行了活检。透析10年或更长时间、年龄50岁或以上以及存在腕管综合征与严重的囊肿评级相关。病变分级与甲状旁腺激素C、铝或β2微球蛋白（B2M）的血清水平之间无关联。8例腕管综合征患者的11个活检骨囊肿中有10个显示出与B2M反应的淀粉样沉积物。我们得出结论，在接受HD治疗的患者腕关节中观察到的囊性透光区表明淀粉样物质沉积。囊肿分级为HD患者淀粉样骨关节病的严重程度提供了一个有用的指标。
