Golder R, Delmez J A, Klahr S
Department of Internal Medicine, Washington University School of Medicine at Barnes-Jewish Hospital, St Louis, MO 63110, USA.
Am J Kidney Dis. 1996 Dec;28(6):918-23. doi: 10.1016/s0272-6386(96)90395-9.
We reviewed the clinical features, laboratory findings, and skeletal abnormalities of six patients who have been on dialysis therapy for 12 to 20 years (average, 16.7 years). Hemodialysis has been the major therapeutic modality in five of the six individuals. Ages of the patients ranged from 28 to 67 years (mean, 44.5). Bone biopsy specimens were available for five of the patients. In three of these, the predominant changes in bone were those of osteitis fibrosa. In two patients with severe osteitis fibrosa, there was a decrease in height. Two patients had predominantly osteomalacia, but in one of these, the condition was noted before the initiation of 13 years of chronic ambulatory peritoneal dialysis, supplanted 2 years ago by hemodialysis. Total parathyroidectomies with implants of parathyroid tissue in the forearm were performed in four of the six patients. All four had, and continue to have, markedly elevated levels of parathyroid hormone (PTH). Symptoms and signs of amyloidosis of bone have occurred in all six patients, including carpal tunnel syndrome in two, bone cysts in three, and presumptive tendon involvement of the shoulder in one patient. The pathogenesis of hyperparathyroidism is described briefly, and appropriate treatment is summarized.
我们回顾了6例接受透析治疗12至20年（平均16.7年）患者的临床特征、实验室检查结果及骨骼异常情况。6例患者中有5例主要采用血液透析治疗。患者年龄在28岁至67岁之间（平均44.5岁）。5例患者有骨活检标本。其中3例，骨骼的主要变化为纤维性骨炎。2例患有严重纤维性骨炎的患者身高下降。2例主要为骨软化症，但其中1例在进行13年的持续性非卧床腹膜透析之前就已出现该情况，2年前被血液透析取代。6例患者中有4例行甲状旁腺全切术并在前臂植入甲状旁腺组织。这4例患者甲状旁腺激素（PTH）水平一直显著升高。所有6例患者均出现了骨淀粉样变性的症状和体征，包括2例腕管综合征、3例骨囊肿以及1例推测的肩部肌腱受累。简要描述了甲状旁腺功能亢进的发病机制，并总结了适当的治疗方法。
