Floege J, Burchert W, Brandis A, Gielow P, Nonnast-Daniel B, Spindler E, Hundeshagen H, Shaldon S, Koch K M
Department of Nephrology, Medizinische Hochschule Hannover, Federal Republic of Germany.
Kidney Int. 1990 Dec;38(6):1169-76. doi: 10.1038/ki.1990.329.
The diagnosis of dialysis-related amyloid (AB-amyloid) has been based usually on clinical and radiological criteria. Following the discovery that beta 2-microglobulin was the major protein of this amyloid, we isolated and radiolabelled uremic plasma beta 2-microglobulin. After intravenous injection, gamma-camera images of selected joint areas were obtained from 42 patients who were on regular hemodialysis therapy. Positive scans involving the shoulder, hip, knee and carpal regions were found in 13 of 14 patients treated for more than 10 years and 10 of 16 patients treated for 5 to 10 years. Patients treated for less time had negative scans. Specificity was indicated by negative scans in non-amyloid inflammatory lesions in control hemodialysis patients. Up to 48-fold tracer enrichment was detected in excised AB-amyloid containing tissue as compared to amyloid-free tissue. These findings suggest that circulating radiolabelled beta 2-microglobulin is taken up by the amyloid deposits. This method may non-invasively detect tissue infiltrates of amyloid. It may also permit prospective evaluation of the efficacy of prophylactic dialysis strategies which are designed to prevent or delay the onset of this complication of long-term dialysis.
透析相关淀粉样变（AB淀粉样变）的诊断通常基于临床和放射学标准。在发现β2-微球蛋白是这种淀粉样变的主要蛋白后，我们分离并对尿毒症血浆β2-微球蛋白进行了放射性标记。静脉注射后，从42例接受常规血液透析治疗的患者中获取了选定关节区域的γ相机图像。在接受治疗超过10年的14例患者中有13例以及接受治疗5至10年的16例患者中有10例在肩部、髋部、膝部和腕部区域出现阳性扫描结果。治疗时间较短的患者扫描结果为阴性。对照血液透析患者非淀粉样炎性病变的阴性扫描结果表明了该方法的特异性。与不含淀粉样变的组织相比，在切除的含AB淀粉样变的组织中检测到示踪剂富集高达48倍。这些发现表明循环放射性标记的β2-微球蛋白被淀粉样沉积物摄取。该方法可能无创检测淀粉样变的组织浸润。它还可能允许对旨在预防或延迟这种长期透析并发症发生的预防性透析策略的疗效进行前瞻性评估。
