Ban Shinichi, Suzuki Syunji, Kubota Kenji, Ohshima Susumu, Satoh Hideaki, Imada Hiroki, Ueda Yoshihiko
Department of Pathology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Saitama, Japan; Department of Pathology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama, Japan.
Department of Nephrology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Saitama, Japan.
Ann Diagn Pathol. 2017 Feb;26:6-9. doi: 10.1016/j.anndiagpath.2016.10.001. Epub 2016 Oct 5.
Lanthanum carbonate is a popular chemical which is administered for patients with end-stage kidney disease to reduce the absorption of phosphate, and lanthanum deposition in the gastroduodenal mucosa has recently been reported. The aim of this study was to assess whether any histologic changes of the gastric mucosa are related to the deposition of lanthanum. Twenty-four patients who revealed the histology of lanthanum deposition on gastroduodenal biopsy between 2011 and 2014 were included in the study, and their clinical records and gastroduodenal biopsies obtained from 2011 to 2015 were reviewed, adding the review of gastroduodenal biopsies before 2011 if possible. Analysis of the deposited materials by scanning electron microscopy-energy dispersive x-ray spectroscopy was performed for a representative gastric biopsy. All patients were diagnosed as having renal insufficiency due to chronic kidney disease and treated with dialysis for more than 5 years, with confirmation of lanthanum carbonate use for 22 patients. Of 121 gastric biopsies and 10 duodenal ones between 2011 and 2015, 86 gastric biopsies (71.1%) and 3 duodenal biopsies (30%), respectively, revealed histology consistent with lanthanum deposition, which was confirmed by scanning electron microscopy-energy dispersive x-ray spectroscopy analysis for a representative case. The deposition tended to occur in the gastric mucosa with regenerative change, intestinal metaplasia, or foveolar hyperplasia (P<.05). Such mucosal changes were observed in about half of the gastric biopsy samples obtained prior to 2010, in which no lanthanum deposition was identified irrespective of the gastric mucosal status. Although direct association between lanthanum deposition and clinical symptoms is not clear, the evaluation of the gastric mucosal status (prior to administration) seems to be important to predict lanthanum deposition when lanthanum carbonate is administered for patients with chronic kidney disease treated with dialysis.
碳酸镧是一种常用药物，用于治疗终末期肾病患者以减少磷酸盐的吸收，最近有报道称其会在胃十二指肠黏膜中沉积。本研究的目的是评估胃黏膜的任何组织学变化是否与镧的沉积有关。本研究纳入了24例在2011年至2014年间胃十二指肠活检显示有镧沉积组织学表现的患者，并回顾了他们2011年至2015年的临床记录及胃十二指肠活检结果，如有可能还增加了对2011年前胃十二指肠活检的回顾。对一份具有代表性的胃活检标本进行了扫描电子显微镜 - 能量色散X射线光谱分析以分析沉积物质。所有患者均因慢性肾病被诊断为肾功能不全，并接受了超过5年的透析治疗，其中22例患者确认使用了碳酸镧。在2011年至2015年间的121份胃活检标本和10份十二指肠活检标本中，分别有86份胃活检标本（71.1%）和3份十二指肠活检标本（30%）显示出与镧沉积一致的组织学表现，这在一份具有代表性的病例中通过扫描电子显微镜 - 能量色散X射线光谱分析得到了证实。沉积倾向于发生在有再生性改变、肠化生或小凹增生的胃黏膜中（P<0.05）。在2010年前获得的约一半胃活检样本中观察到了此类黏膜变化，其中无论胃黏膜状态如何均未发现镧沉积。虽然镧沉积与临床症状之间的直接关联尚不清楚，但在对接受透析治疗的慢性肾病患者使用碳酸镧时，评估（给药前的）胃黏膜状态对于预测镧沉积似乎很重要。
