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目的:总结肩关节透析相关性淀粉样变(DRA)的临床特点和磁共振(MRI)的诊断价值。方法:选取具有肩关节疼痛、僵硬、肿胀等症状并排除继发性甲状旁腺功能亢进的维持性血透(MHD)患者12例为症状组,无症状MHD患者12例为对照组。比较两组的年龄、透析时间、β2微球蛋白(β2-M)。MRI检查双侧肩关节,测量岗上肌肌腱与肩胛下肌肌腱厚度,观察骨质破坏情况。结果:症状组年龄、透析时间、血清β2-M均显著高于对照组(P<0.05);症状组岗上肌肌腱和肩胛下肌肌腱增厚显著大于对照组(P<0.01)。症状组MRI检查阳性100%,对照组25%;症状组7例骨质破坏,对照组发现1例轻微骨质破坏。结论:年龄大、透析时间长的患者更易表现出DRA临床症状,症状轻重与关节受损程度有关。MRI可有效发现DRA的征象,无症状者的肩关节也有MRI阳性发现,提示MRI对DRA的早期诊断有肯定价值。
Objective: To summarize the clinical features of dialysis-related amyloidosis (DRA) in the shoulder and the diagnostic value of magnetic resonance imaging (MRI). Methods: Twelve patients with maintenance hemodialysis (MHD) who had symptoms of shoulder joint pain, stiffness and swelling and excluded secondary hyperparathyroidism were selected as symptom group and 12 asymptomatic MHD patients as control group. The age, dialysis time, β2-microglobulin (β2-M) were compared between the two groups. MRI examination of bilateral shoulder joint, measurement of supraspinatus tendon and subscapularis tendon thickness, observed bone destruction. Results: The age, dialysis time and serum β2-M in the symptom group were significantly higher than those in the control group (P <0.05). The thickening of tendon in supraspinatus tendon and subscapularis muscle in symptom group was significantly larger than that in control group (P <0.01). The MRI examination of the symptom group was 100% positive and 25% in the control group. Seven cases of bone destruction were found in the symptom group, and one case of slight bone destruction was found in the control group. Conclusion: Patients with large age and long dialysis time are more likely to show clinical symptoms of DRA. The severity of symptoms is related to the degree of joint damage. MRI can effectively find the signs of DRA, asymptomatic shoulder also MRI positive findings, suggesting that MRI has certain value in the early diagnosis of DRA.