10例尿毒症钙化防御患者临床特点及预后分析

    Clinical characteristics and outcomes of 10 uremics with calciphylaxis

    • 摘要: 目的总结尿毒症钙化防御患者的临床特点和预后情况。方法纳入2019年1月1日至2019年12月31日于大连市中心医院肾内科确诊为钙化防御的尿毒症患者,回顾性分析其临床表现、病理表现及预后情况。结果本研究共纳入钙化防御患者10例,男女比例为1:1,年龄(52.3±17.4)岁,中位透析龄120(60,153)个月,以远端皮肤坏死性溃疡伴严重顽固性疼痛为主要临床表现。50%以上的患者有钙剂、骨化三醇连续性口服1年以上的用药史。多数患者血红蛋白低(91.1±17.3)g/L、白蛋白低(31.3±5.0)g/L,血磷高(2.14±0.81)mmol/L,而总钙、校正钙水平正常。全部患者均存在继发性甲状旁腺功能亢进,全段甲状旁腺素历史最高值平均达1488.2 ng/L。治疗方案以硫代硫酸钠静脉滴注改善血管钙化为主,辅以止痛、清创、局部氧疗、营养支持等对症治疗。研究期间内共计有5例患者死亡,其中4例为心源性猝死,1例为感染性休克。从确诊到死亡的中位时间为6.1个月(8 d至11个月)。结论尿毒症钙化防御患者具有透析龄长、营养状态差、贫血、合并严重继发性甲状旁腺亢进的临床特点,出现症状确诊后生存时间短,预后较差,提示应加强对尿毒症患者甲状旁腺激素水平的管理,早期诊断、早期治疗,以改善预后。

       

      Abstract: Objective To explore the clinical characteristics and outcomes of calciphylaxis in uremics.Methods From January,2019 to December,2019,10 uremics with calciphylaxis were selected.Clinical manifestations,pathological features and outcomes were analyzed retrospectively.Results Ten patients with calciphylaxis were enrolled. There were 5 boys and 5 girls with an average age of(52.3±17.4)years and a median dialysis age of 120(60-153)months. The major clinical feature was distal skin necrotic ulcer with severe intractable pain. More than one half had a previous history of continuous oral dosing of calcium and calcitriol for more than 1 year. The levels of albumin(31.3±5.0)g/L,hemoglobin(91.1±17.3)g/L and serum phosphorus(2.14±0.81)mmol/L were significantly lower in calciphylaxis patients than normal. The levels of similar total calcium and corrected calcium were similar. All of them had secondary hyperparathyroidism and the average historical peak of parathyroid hormone was1488.2 pg/ml. Treatment consisted of intravenous infusion of sodium thiosulfate and such symptomatic measures as analgesics,debridement,wound care,local oxygen therapy and nutritional supports. Overall 1-year mortality was 50%(5/10)at the end of follow-up. Cause of death was sudden cardiogenic arrest(n=4)and septic shock(n=1). The median time from diagnosis to death was 6.1 months(8 days to 11months).Conclusion Calciphylaxis has clinical features of long dialysis age,poor nutritional status,anemia and secondary parathyroidism in uremics. Also calciphylaxis is associated with a high mortality rate.Thus a proper management of parathyroid hormone level should be strengthened. And early diagnosis and prompt treatment are implemented for improving its prognosis.

       

    /

    返回文章
    返回