McMahon L P, Radford J, Dawborn J K
Department of Medicine, Austin Hospital, Heidelberg, Victoria, Australia.
Clin Nephrol. 1991 May;35(5):227-32.
Ultrasonographic changes around the shoulder joint were compared in ten symptomatic patients with dialysis related amyloid (DRA) and seventeen patients without symptoms. All patients had been on long-term (greater than 7 years) hemodialysis (HD). Three control groups were used: 8 predialysis patients, 10 continuous ambulatory peritoneal dialysis (CAPD) and 9 HD patients who had been on dialysis for less than two years. Dry bodyweight, sex, handedness, length of hemodialysis and fistula side were not significantly different between the study groups. Proven amyloid patients were significantly older than other groups (p less than 0.001). Parameters assessed included cross-sectional area of long head of biceps tendon (LHB), diameter of supraspinatus tendon (SS), and general features (bursae, deposits) around the joint. Results demonstrated significant differences in all parameters in patients with symptomatic amyloid compared with other long-term patients: [SS: 7.4 mm +/- 0.7, mean +/- SEM, vs 5.1 +/- 0.2 (right, R), p = 0.001; 6.7 +/- 0.7 vs 4.9 +/- 0.2 (left, L), p = 0.01. LHB: 140.0 mm2 +/- 11.1 vs 79.6 +/- 5.1 (R), p less than 0.001; 114.5 +/- 10.5 vs 80.8 +/- 5.4 (L), p = 0.004. Bursae: 5 vs 1 (patients), p = 0.006]. Compared with controls changes in the amyloid group were less marked though in most cases still significant. There was no significant difference between control groups nor between controls and asymptomatic long-term HD patients in any parameter. We conclude that shoulder ultrasound may have a role in identifying patients with dialysis related amyloid. Serial measurements may also help to elucidate the pathogenesis of the tendon changes.
对10例有症状的透析相关性淀粉样变（DRA）患者和17例无症状患者的肩关节周围超声变化进行了比较。所有患者均接受长期（超过7年）血液透析（HD）。使用了三个对照组：8例透析前患者、10例持续性非卧床腹膜透析（CAPD）患者和9例透析时间少于两年的HD患者。研究组之间的干体重、性别、利手、血液透析时间和瘘管侧无显著差异。确诊的淀粉样变患者比其他组明显年龄更大（p<0.001）。评估的参数包括肱二头肌长头（LHB）的横截面积、冈上肌腱（SS）的直径以及关节周围的一般特征（滑囊、沉积物）。结果表明，有症状淀粉样变患者与其他长期患者相比，所有参数均存在显著差异：[SS：7.4 mm±0.7，平均±标准误，右侧（R）为5.1±0.2，p = 0.001；左侧（L）为6.7±0.7 vs 4.9±0.2，p = 0.01。LHB：140.0 mm2±11.1 vs 79.6±5.1（R），p<0.001；114.5±10.5 vs 80.8±5.4（L），p = 0.004。滑囊：患者为5例 vs 1例，p = 0.006]。与对照组相比，淀粉样变组的变化虽不太明显，但在大多数情况下仍具有显著性。对照组之间以及对照组与无症状长期HD患者之间在任何参数上均无显著差异。我们得出结论，肩部超声可能在识别透析相关性淀粉样变患者中发挥作用。连续测量也可能有助于阐明肌腱变化的发病机制。
