Ong Suyin, Coulson I H
Department of Dermatology, Burnley General Hospital, Casterton Avenue, Burnley BB10 2PQ, United Kingdom.
Skinmed. 2012 May-Jun;10(3):166-70.
Calciphylaxis occurs due to calcium deposition in arterioles, which leads to ischemic ulceration of overlying skin. Two-year mortality rates from sepsis ranges from 50% to 80%. Calciphylaxis is most common in hyperparathyroidism secondary to chronic renal impairment and rarely occurs in the setting of normal renal function. Biopsy of the calciphylaxis ulcer reveals calcium deposits lining the vascular intima. Tissue calcification may also be seen on plain radiographs. Calcium-phosphate metabolism should be normalized by treating any underlying hyperparathyroidism with bisphosphonates, parathyroidectomy, and/or cinacalcet in addition to dialysis in chronic renal failure. Intravenous sodium thiosulfate has been used successfully to treat renal and normo-renal calciphylaxis. Sodium thiosulfate displaces calcium ions from calcium deposits to form calcium thiosulfate, which is excreted by the kidneys or dialyzed. Systemic glucocorticoids may prevent ulceration of early plaques of calciphylaxis. Hyperbaric oxygen, skin grafting, and iloprost infusions are useful adjuncts in the management of this debilitating condition.
钙过敏症是由于钙在小动脉中沉积所致，这会导致覆盖其上的皮肤出现缺血性溃疡。脓毒症导致的两年死亡率在50%至80%之间。钙过敏症在继发于慢性肾功能损害的甲状旁腺功能亢进症中最为常见，在肾功能正常的情况下很少发生。钙过敏症溃疡的活检显示血管内膜有钙沉积。在普通X线片上也可见组织钙化。除了对慢性肾衰竭进行透析外，还应通过使用双膦酸盐、甲状旁腺切除术和/或西那卡塞治疗任何潜在的甲状旁腺功能亢进症，使钙磷代谢恢复正常。静脉注射硫代硫酸钠已成功用于治疗肾性和非肾性钙过敏症。硫代硫酸钠将钙离子从钙沉积物中置换出来，形成硫代硫酸钙，后者由肾脏排出或通过透析清除。全身性糖皮质激素可预防钙过敏症早期斑块的溃疡形成。高压氧、皮肤移植和伊洛前列素输注是治疗这种使人衰弱疾病的有用辅助手段。
