Milliner D S, Nebeker H G, Ott S M, Andress D L, Sherrard D J, Alfrey A C, Slatopolsky E A, Coburn J W
Ann Intern Med. 1984 Dec;101(6):775-9. doi: 10.7326/0003-4819-101-6-775.
The accumulation of aluminum in bone can cause disabling osteodystrophy in patients with renal failure. Because the chelating agent deferoxamine can mobilize aluminum from tissues, we evaluated the effect of a standard intravenous dose of deferoxamine on plasma aluminum concentrations in 54 patients on hemodialysis. Stainable bone aluminum, bone histologic findings, and bone aluminum content were studied. Baseline plasma aluminum concentrations of greater than 200 micrograms/L were associated with aluminum-related osteodystrophy (specificity, 93%), but concentrations of less than 200 micrograms/L did not exclude the diagnosis (sensitivity, 43%). After administration of deferoxamine, the increase in plasma aluminum concentration was 534 +/- 260 (SD) and 214 +/- 92 micrograms/L in patients with and without aluminum-related bone disease, respectively (p less than 0.001), and correlated with the bone aluminum content (r = 0.64). An increment in plasma aluminum concentration of greater than 200 micrograms/L identified 35 of the 37 patients with aluminum-related osteodystrophy; sensitivity was 94% and specificity, 50%. The deferoxamine infusion test is noninvasive, well tolerated, and of value particularly in excluding the diagnosis of aluminum-related osteodystrophy.
铝在骨中的蓄积可导致肾衰竭患者出现致残性骨营养不良。由于螯合剂去铁胺可促使铝从组织中释放出来，我们评估了标准静脉剂量的去铁胺对54例血液透析患者血浆铝浓度的影响。研究了可染色骨铝、骨组织学表现及骨铝含量。基线血浆铝浓度大于200微克/升与铝相关性骨营养不良有关（特异性为93%），但浓度低于200微克/升并不能排除诊断（敏感性为43%）。给予去铁胺后，有和无铝相关性骨病的患者血浆铝浓度分别升高534±260（标准差）和214±92微克/升（p<0.001），且与骨铝含量相关（r=0.64）。血浆铝浓度升高大于200微克/升可识别出37例铝相关性骨营养不良患者中的35例；敏感性为94%，特异性为50%。去铁胺输注试验是非侵入性的，耐受性良好，尤其在排除铝相关性骨营养不良的诊断方面具有价值。
