Artunc Ferruh, Haap Michael, Heyne Nils, Weyrich Peter, Wolf Sabine
Medizinische Universitätsklinik Tübingen, Abteilung für Endokrinologie, Diabetologie, Nephrologie, Angiologie und Klinische Chemie.
Dtsch Med Wochenschr. 2010 Feb;135(6):240. doi: 10.1055/s-0030-1247609. Epub 2010 Feb 2.
We report on a female patient with rheumatoid arthritis and end-stage renal-disease following AA-amyloidosis who presented with chest pain to the emergency department.
ECG showed no signs of ischemia, echocardiography revealed a concentric left ventricular hypertrophy with increased texture. Serum concentration of troponin I was mildly elevated whereas creatine kinase (CK)/ CK-MB were normal.
DIAGNOSIS, TREATMENT AND COURSE: The chief complaints resolved spontaneously and there was no change in the serum troponin-I and CK/CK-MB concentrations. Coronary heart disease was ruled out by angiography and cardiac involvement of the underlying AA-amyloidosis was diagnosed. After one month, the patient suffered from a syncope complicated by a pelvic ring fracture with hemorrhagic shock and declined chronic dialysis treatment.
Patients with end-stage renal disease may exhibit a persisting elevation of serum troponin concentration reflecting the high burden of cardiovascular disease. Myocardial infarction can be distinguished by the lack of increase in serial tests.
我们报告一例患有类风湿性关节炎且因AA型淀粉样变性导致终末期肾病的女性患者，该患者因胸痛前往急诊科就诊。
心电图未显示缺血迹象，超声心动图显示左心室向心性肥厚且心肌纹理增强。肌钙蛋白I血清浓度轻度升高，而肌酸激酶（CK）/CK-MB正常。
诊断、治疗与病程：主要症状自行缓解，肌钙蛋白I和CK/CK-MB血清浓度无变化。血管造影排除了冠心病，并诊断为潜在的AA型淀粉样变性累及心脏。一个月后，患者发生晕厥，并发骨盆环骨折伴失血性休克，拒绝接受慢性透析治疗。
终末期肾病患者可能出现血清肌钙蛋白浓度持续升高，这反映了心血管疾病的高负担。通过系列检查中无升高可鉴别心肌梗死。
