Drüeke T, Touam M, Zingraff J
INSERM Unité 90, Hôpital Necker, Paris, France.
Adv Ren Replace Ther. 1995 Jan;2(1):24-39. doi: 10.1016/s1073-4449(12)80069-0.
Dialysis-related arthropathy represents a major complication of uremic patients treated by hemodialysis or other renal replacement therapies. Nearly 10 years ago, this syndrome was shown to be associated with a new type of amyloid, mainly composed of beta-2 microglobulin (beta 2-M). Retention of the beta 2-M protein due to chronic renal failure, although unquestionably a prerequisite for the occurrence of beta 2-M amyloidosis, appears not to be the unique pathogenetic factor involved in this complication. A role has also been attributed to an enhanced local or systemic generation of inflammatory mediators, an increased production of beta 2-M, and an altered metabolism of the molecule including partial proteolysis and glycation. It is possible that factors related to renal replacement therapy such as dialysis membrane biocompatibility also play a role. However, the clarification of the precise underlying mechanism(s) awaits further study. Because dialysis technology has progressed considerably during the last decade, a significant beta 2-M removal can be achieved at present using high-flux dialyzers. Moreover, a marked reduction in bioincompatibility during the dialysis procedure as manifested by activation of complement and stimulation of mononuclear blood cells can now be attained. Future studies will tell whether technical progress in dialysis technique results in a decrease in the incidence of symptomatic dialysis-associated amyloidosis.
透析相关性关节病是接受血液透析或其他肾脏替代疗法的尿毒症患者的主要并发症。近10年前，该综合征被证明与一种新型淀粉样蛋白有关，主要由β2微球蛋白（β2-M）组成。尽管慢性肾衰竭导致β2-M蛋白潴留无疑是β2-M淀粉样变性发生的先决条件，但似乎并非参与这一并发症的唯一致病因素。炎症介质的局部或全身生成增强、β2-M产生增加以及包括部分蛋白水解和糖基化在内的分子代谢改变也被认为起了作用。与肾脏替代疗法相关的因素如透析膜生物相容性也可能起作用。然而，确切的潜在机制仍有待进一步研究。由于在过去十年中透析技术有了很大进展，目前使用高通量透析器可以显著清除β2-M。此外，现在可以实现透析过程中生物不相容性的显著降低，表现为补体激活和单核血细胞刺激。未来的研究将表明透析技术的进步是否会导致有症状的透析相关性淀粉样变性发病率降低。
