Campistrus de Gencarelli N, Cournot-Witmer G, Zingraff J, Drüeke T
Nephrol Dial Transplant. 1986;1(3):192-8.
Aluminium (Al) intoxication in patients with chronic renal failure may lead to osteomalacia, microcytic anaemia, and encephalopathy. It has been suggested that the expression of Al toxicity may be related to the function of the parathyroid glands. The purpose of this study was to determine whether the functional state of the parathyroids influenced the evolution of Al-related encephalopathy in Al-intoxicated haemodialysed patients. The patients were subdivided into two groups according to outcome: group I patients (n = 6) had died with the clinical feature of severe cerebral dysfunction; group II patients (n = 15) had a favourable outcome with partial or complete recovery. The degree of hyperparathyroidism, as evaluated by plasma biochemistry and bone histology, was comparable in both groups. Three patients of group I and five of group II underwent parathyroidectomy. Before the clinical onset of encephalopathy the duration of Al overload in group I was not different from group II, but after its onset patients of group I were intoxicated significantly longer (8 months +/- 6.6) than those of group II (1.5 months +/- 1.9). This study shows that, in uraemic patients with Al-related encephalopathy, parathyroid function and parathyroidectomy do not play an essential role in clinical outcome. The duration of Al intoxication following the first signs of encephalopathy appears to be the major prognostic element.
慢性肾衰竭患者的铝（Al）中毒可能导致骨软化症、小细胞性贫血和脑病。有人提出，铝毒性的表现可能与甲状旁腺的功能有关。本研究的目的是确定甲状旁腺的功能状态是否会影响铝中毒血液透析患者铝相关性脑病的进展。根据预后情况将患者分为两组：第一组患者（n = 6）死于严重脑功能障碍的临床特征；第二组患者（n = 15）预后良好，部分或完全康复。通过血浆生物化学和骨组织学评估的甲状旁腺功能亢进程度在两组中相当。第一组3例患者和第二组5例患者接受了甲状旁腺切除术。在脑病临床发作前，第一组铝过载的持续时间与第二组无差异，但发作后，第一组患者中毒时间（8个月±6.6）明显长于第二组（1.5个月±1.9）。本研究表明，在患有铝相关性脑病的尿毒症患者中，甲状旁腺功能和甲状旁腺切除术对临床结局不起关键作用。脑病首发症状后铝中毒的持续时间似乎是主要的预后因素。
