Department of Pathology, Osaka Medical College, 2-7 Daigaku-cho, Takatsuki, Osaka, Japan.
Department of Pathology, Moriguchi Keijinkai Hospital, 2-47-12, Yagumohigashi-machi, Moriguchi, Osaka, 570-0021, Japan.
Pathol Int. 2017 Sep;67(9):447-452. doi: 10.1111/pin.12564. Epub 2017 Aug 11.
Lanthanum (La) deposition has been observed in gastrointestinal mucosa of dialysis patients treated with La carbonate to treat hyperphosphatemia in the 6 years since its authorization in Japan. We investigated gastrointestinal biopsies from 112 dialysis patients, and found 15 cases of histiocytic aggregation with crystalloids and one case of duodenitis with histiocyte aggregation without crystalloids in the 30 patients treated with La carbonate. No histiocytic lesions were observed in the 82 patients without La carbonate administration. So far in total 70 cases of La deposition in the alimentary tract have been reported, including our 16 cases. Neither clinical nor histological findings other than histiocytic aggregation were specific in the patients with La deposition. We also compared the groups with and without La deposition, revealing that the daily and total doses of La carbonate showed statistically significant correlations with La deposition. However the causality with their histologic features, e.g. intestinal metaplasia and degree of inflammation, were inconclusive between the two groups. Although no critical symptoms have been reported, it is necessary to accumulate more cases to clarify the mechanism of La deposition, because dialysis patients must take phosphate buffers for a long period.
镧（La）沉积已在接受 La 碳酸盐治疗以治疗高磷血症的透析患者的胃肠道黏膜中观察到，自日本批准以来已有 6 年。我们调查了 112 名透析患者的胃肠道活检，发现 30 名接受 La 碳酸盐治疗的患者中有 15 例存在含结晶物的组织细胞聚集和 1 例无结晶物的十二指肠炎伴组织细胞聚集。在未接受 La 碳酸盐治疗的 82 名患者中未观察到组织细胞病变。迄今为止，共报告了 70 例胃肠道 La 沉积病例，包括我们的 16 例。在 La 沉积患者中，除组织细胞聚集外，临床和组织学发现均无特异性。我们还比较了有和没有 La 沉积的组，发现 La 碳酸盐的日剂量和总剂量与 La 沉积呈统计学显著相关。然而，两组之间在其组织学特征（如肠上皮化生和炎症程度）方面的因果关系尚无定论。虽然没有报告严重的症状，但有必要积累更多的病例来阐明 La 沉积的机制，因为透析患者必须长期服用磷酸盐缓冲剂。
