Kriegshauser J S, Swee R G, McCarthy J T, Hauser M F
Radiology. 1987 Aug;164(2):399-403. doi: 10.1148/radiology.164.2.3602376.
Aluminum toxicity in patients undergoing dialysis currently requires bone biopsy for definitive diagnosis. The authors retrospectively reviewed clinical, histologic, and radiographic findings in 63 patients undergoing dialysis. In 30 patients, biopsy specimens were negative for aluminum toxicity, and in 33 patients, specimens were positive. In 21 of the 30 patients who had a negative biopsy specimen, absence of aluminum toxicity could be predicted by a high immunoreactive parathyroid hormone level (greater than 2,000 microliter Eq/ml [2,210 pM]) and fewer than three fractures, by the presence of osteosclerosis on radiographs, or if serum aluminum levels were less than 30 ng/ml. None of the patients who had a positive biopsy specimen met these criteria. In 18 of 33 patients who had a positive biopsy specimen, aluminum toxicity could be predicted by a low immunoreactive parathyroid hormone level (less than 500 microliter Eq/ml [553 pM]) and more than three fractures, or if serum aluminum levels were greater than 300 ng/ml. None of the patients who had a negative biopsy specimen met these criteria. Thus, based on the criteria identified, the aluminum status of 62% of these patients would have been correctly diagnosed.
目前，接受透析的患者发生铝中毒需要通过骨活检来确诊。作者回顾性分析了63例接受透析患者的临床、组织学和影像学检查结果。30例患者的活检标本铝中毒检测为阴性，33例为阳性。在活检标本阴性的30例患者中，21例可通过以下情况预测无铝中毒：高免疫反应性甲状旁腺激素水平（大于2,000微升当量/毫升[2,210皮摩尔]）、骨折少于三处、X线片显示存在骨硬化，或血清铝水平低于30纳克/毫升。活检标本阳性的患者均不符合这些标准。在活检标本阳性的33例患者中，18例可通过以下情况预测铝中毒：低免疫反应性甲状旁腺激素水平（小于500微升当量/毫升[553皮摩尔]）、骨折多于三处，或血清铝水平高于300纳克/毫升。活检标本阴性的患者均不符合这些标准。因此，根据所确定的标准，这些患者中有62%的铝状态能够得到正确诊断。
