Angelis M, Wong L L, Myers S A, Wong L M
Department of Surgery, John A Burns School of Medicine, University of Hawaii, Honolulu, USA.
Surgery. 1997 Dec;122(6):1083-9; discussion 1089-90. doi: 10.1016/s0039-6060(97)90212-9.
Calciphylaxis is characterized by painful, violaceous, mottled skin lesions (livedo reticularis) that may progress to tissue necrosis, nonhealing ulcers, gangrene, and potentially amputation, sepsis, or death. The prevalence and characteristics of patients who have calciphylaxis need further identification to predict which patients on dialysis may benefit from close monitoring or early surgical intervention.
All 242 patients undergoing hemodialysis in an outpatient unit were reviewed retrospectively during a 15-month cross-sectional study of the prevalence and characteristics of calciphylaxis.
Ten patients (prevalence, 4.1%) had calciphylaxis. Patients with calciphylaxis were significantly younger (49 versus 60 years; p = 0.01), had undergone hemodialysis longer (80 versus 20 months; p < 0.0001), and had higher median serum calcium (9.7 versus 9.2 mg/dl; p = 0.03), phosphate (8.2 versus 5.7 mg/dl; p = 0.001), calcium phosphate product (81.5 versus 52.9; p = 0.0004), parathyroid hormone (1496 versus 138 pg/ml; p < 0.0001), and alkaline phosphatase levels (188 versus 89 IU/L; p = 0.0001). Bone surveys were positive in all 10 patients with calciphylaxis compared with 49 (21%) of the 232 patients without calciphylaxis (p < 0.0001). All patients who underwent parathyroidectomy for calciphylaxis had dramatic healing of the ulcers.
The presence of calciphylaxis is higher among younger patients who had undergone longer periods of hemodialysis. Therefore this group of patients should be monitored aggressively and treated expeditiously for complications of secondary hyperparathyroidism.
钙过敏症的特征为疼痛性、紫红色、斑驳状皮肤损害（网状青斑），可进展为组织坏死、不愈合溃疡、坏疽，并可能导致截肢、败血症或死亡。需要进一步明确钙过敏症患者的患病率和特征，以预测哪些透析患者可能从密切监测或早期手术干预中获益。
在一项为期15个月的关于钙过敏症患病率和特征的横断面研究中，对门诊接受血液透析的所有242例患者进行了回顾性分析。
10例患者（患病率为4.1%）患有钙过敏症。患有钙过敏症的患者明显更年轻（49岁对60岁；p = 0.01），血液透析时间更长（80个月对20个月；p < 0.0001），血清钙中位数更高（9.7mg/dl对9.2mg/dl；p = 0.03），磷酸盐（8.2mg/dl对5.7mg/dl；p = 0.001），钙磷乘积（81.5对52.9；p = 0.0004），甲状旁腺激素（1496pg/ml对138pg/ml；p < 0.0001），以及碱性磷酸酶水平（188IU/L对89IU/L；p = 0.0001）。与232例无钙过敏症患者中的49例（21%）相比，所有10例钙过敏症患者的骨扫描均呈阳性（p < 0.0001）。所有因钙过敏症接受甲状旁腺切除术的患者溃疡均显著愈合。
在接受血液透析时间较长的年轻患者中，钙过敏症的发生率较高。因此，应对这组患者进行积极监测，并对继发性甲状旁腺功能亢进的并发症进行及时治疗。
