Takahashi M, Hoshino H, Kushida K, Murata H, Baba S, Inoue T
Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.
Nephron. 1998 Dec;80(4):444-9. doi: 10.1159/000045218.
BACKGROUND/AIMS: Carpal tunnel syndrome (CTS) is a major complication that occurs in the musculoskeletal system in patients on long-term hemodialysis (HD). Pentosidine is an advanced glycation endproduct (AGE) and there is evidence that shows AGEs contribute to the pathogenesis of the complications in patients undergoing HD. The aim of this study is to investigate whether pentosidine accumulates in the carpal ligament in patients undergoing HD with CTS in comparison with idiopathic CTS.
Carpal ligaments and skin were obtained during surgery from 28 patients with CTS undergoing HD and 13 patients with idiopathic CTS (ID CTS). Pentosidine was measured by HPLC after hydrolysis of the samples, and amyloid deposits in the samples of HD CTS were examined histologically.
Pentosidine levels in ligament and skin were significantly higher in HD CTS than ID CTS. On the other hand, there was no difference in pyridinoline which is a physical cross-link between HD and ID CTS. Amyloid deposits were observed in 14 ligament samples, whereas there was none in 14 other samples. There was no significant difference in pentosidine and pyridinoline in ligament, pentosidine in skin, duration of HD and serum beta2-microglobulin between the amyloid+ group and the amyloid- group.
A greater concentration of pentosidine in the carpal ligament in HD patients compared with idiopathic patients suggests that an accumulation of AGEs contributes to one of the pathologies of occurrence of CTS in patients undergoing HD.
背景/目的：腕管综合征（CTS）是长期血液透析（HD）患者肌肉骨骼系统中发生的一种主要并发症。戊糖苷是一种晚期糖基化终产物（AGE），有证据表明AGEs参与HD患者并发症的发病机制。本研究的目的是调查与特发性CTS相比，戊糖苷是否在HD合并CTS患者的腕横韧带中蓄积。
手术中获取28例HD合并CTS患者及13例特发性CTS（ID CTS）患者的腕横韧带和皮肤。样品水解后通过高效液相色谱法测定戊糖苷，并对HD CTS样品中的淀粉样沉积物进行组织学检查。
HD CTS患者韧带和皮肤中的戊糖苷水平显著高于ID CTS患者。另一方面，HD患者和ID CTS患者之间作为物理交联的吡啶啉没有差异。在14个韧带样品中观察到淀粉样沉积物，而在其他14个样品中未观察到。淀粉样蛋白阳性组和淀粉样蛋白阴性组之间韧带中的戊糖苷和吡啶啉、皮肤中的戊糖苷、HD持续时间和血清β2-微球蛋白没有显著差异。
与特发性患者相比，HD患者腕横韧带中戊糖苷浓度更高，这表明AGEs的蓄积是HD患者发生CTS的病理原因之一。
