Maruyama S
Department of Medicine (II), Niigata University Medical School, Japan.
Nihon Jinzo Gakkai Shi. 1998 Nov;40(8):573-86.
Amyloid osteoarthropathy has been seen frequently in long-term hemodialysis (HD) patients, in which the bone X-ray examination reveals characteristic cystic radiolucency (CRL) of the carpal bone, shoulder joint, hip joint and knee joint, and destructive spondylarthropathy (DSA) of cervical vertebrae. To clarify the clinico-pathological significance of CRL and DSA in HD-related amyloidosis, we investigated the grade and frequency of CRL or DSA and these relationship with age, HD duration, primary diseases, osteoarticular symptoms and blood analysis in 817 HD patients (492 male and 325 female, age: 52.6 + 15.5 years, dialysis duration: 6.8 + 5.4 years). The number of cases with osteoarticular symptoms increased with the prolongation of HD duration. CRL and DSA were observed even in patients without osteoarticular symptoms: 26.7% for carpal bone, 26.2% for shoulder joint, 17.3% for hip joint and 22.2% for DSA. The grade and frequency of CRL and DSA also increased in accordance with age and HD duration. In patients with CRL of the carpal bone, shoulder CRL was noticed in 39.7%, hip CRL in 25.8%, and DSA in 14.3% of cases, respectively, and these frequencies increased with the prolongation of HD duration. In the carpal CRL negative group, shoulder CRL was noticed in 14.6%, hip CRL in 7.5%, and DSA in 6.0%, respectively. Although there was no relationship between CRL or DSA and serum beta 2-MG level in any of the cases, the serum beta 2-MG level was lower in patients with HD showing shoulder CRL (+2) and DSA (+) for more than 16 years. No significant relationship was noticed between CRL or DSA and serum C-PTH and aluminum level. These results suggested that aging was related to CRL or DSA formation in dialysis-related amyloidosis. The findings also suggested that systemic bone X-ray examination should be considered in patients with carpal bone CRL, high-age patients and long-term HD patients even without osteoarticular symptoms.
淀粉样骨关节病在长期血液透析（HD）患者中较为常见，其骨X线检查显示腕骨、肩关节、髋关节和膝关节有特征性的囊性透亮区（CRL），以及颈椎的破坏性脊椎关节病（DSA）。为阐明CRL和DSA在HD相关淀粉样变性中的临床病理意义，我们调查了817例HD患者（男性492例，女性325例，年龄：52.6±15.5岁，透析时间：6.8±5.4年）中CRL或DSA的分级和频率，以及它们与年龄、HD持续时间、原发疾病、骨关节症状和血液分析的关系。骨关节症状的病例数随HD持续时间的延长而增加。即使在没有骨关节症状的患者中也观察到了CRL和DSA：腕骨为26.7%，肩关节为26.2%，髋关节为17.3%，DSA为22.2%。CRL和DSA的分级和频率也随年龄和HD持续时间的增加而增加。在有腕骨CRL的患者中，分别有39.7%的病例出现肩关节CRL，25.8%的病例出现髋关节CRL，14.3%的病例出现DSA，且这些频率随HD持续时间的延长而增加。在腕骨CRL阴性组中，分别有14.6%的病例出现肩关节CRL，7.5%的病例出现髋关节CRL，6.0%的病例出现DSA。虽然在任何病例中CRL或DSA与血清β2-MG水平之间均无相关性，但HD时间超过16年且出现肩关节CRL（+2）和DSA（+）的患者血清β2-MG水平较低。未发现CRL或DSA与血清C-PTH和铝水平之间有显著相关性。这些结果表明，衰老与透析相关淀粉样变性中CRL或DSA的形成有关。研究结果还表明，对于有腕骨CRL的患者、高龄患者和长期HD患者，即使没有骨关节症状，也应考虑进行全身骨X线检查。
