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ESR增高是AS发生肾淀粉样变性的唯一独立危险因素

作者:Barbouch S,et al 翻译:山东省中医院张艳艳 来源:中国风湿病公众论坛 日期:2018-06-14
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         ESR增高是AS发生肾淀粉样变性的唯一独立危险因素

关键字:  ESR | AS 

        摘要:继发性肾淀粉样变性(RA)是强直性脊柱炎中最常见的肾脏受累类型。我们评估伴有淀粉样变性的AS患者的流行病学和临床生物学特征,分析治疗方式和预后因素,以及确定AS中继发性肾淀粉样变性预测因素。回顾性研究了1978年至2006年期间212例AS患者中的13例继发性肾淀粉样变性患者。诊断AS时患者的中位年龄为47岁(范围:19-67)。有11例男性和2例女性。确诊AS平均随访144.6个月(范围:10-505)后诊断继发性肾淀粉样变性发病。我们注意到侵蚀性外周关节炎,腰椎僵硬与脊柱竹节样改变,髋关节炎分别占23.1%、76.9%和30.8%。在8例患者中发现肾病综合征(61.5%)。在诊断继发性肾淀粉样变性时,6例患者出现肾功能衰竭。6例(46.1%)唾液腺活检证实淀粉样蛋白沉积,7例(53.8%)肾活检证实淀粉样沉积。4例患者接受了秋水仙碱的长疗程治疗,仅有2例疾病结局良好。在我们的研究中,继发性肾淀粉样变性患者中AS更严重,发现四种预测因素:吸烟(P = 0.04),侵蚀性外周关节炎(P = 0.002),脊柱竹节样改变(P = 0.001)和炎症生物学指标(P = 0.0001)。ESR增高是AS发生继发性肾淀粉样变性唯一的独立危险因素(P = 0.0001)。应定期监测肾功能以及尿液分析,以检测AS期间早期肾脏受累情况。

        附原文:Abstract Secondary renal amyloidosis (RA) is the most common type of renal involvement in ankylosing spondylitis (AS). We assessedthe epidemiologic and clinico-biological profile of AS patients with RA, to analyze treatment modalities and prognostic aspects, and to determine predictive factors of RA during AS. This was a retrospective study including 13 cases of RA among 212 cases who presented with AS, during the period from 1978 to 2006. The median age of the patients at the time of diagnosing AS was 47 years (range: 19-67). There were 11 males and two females. RA onset was diagnosed after a mean follow-up of 144.6 months (range: 10-505) from the AS diagnosis. We noted erosive peripheral arthritis, lumbar stiffness with bamboo spine, and coxitis in 23.1%, 76.9%, and 30.8% of cases, respectively. Nephrotic syndrome was found in eight patients (61.5%). At the time of diagnosing RA, six patients had renal failure. Amyloid deposits were histologically proven by salivary gland biopsy in six cases (46.1%) and by renal biopsy in seven cases (53.8%). Four patients received a long-course treatment with colchicine but with a good outcome only in two cases. In our series, AS was more severe among patients with RA. Four predictive factors of RA were identified: smoking (P = 0.04), erosive peripheral arthritis (P = 0.002), bamboo spine (P = 0.001), and biologic indicators of inflammation (P = 0.0001). High erythrocyte sedimentation rate was identified as the only independent risk factor of RA during AS (P = 0.0001). Renal function as well as urinalysis should be monitored at regular intervals to detect early renal involvement during AS.

        引自:Barbouch S, Hajji M, Jaziri F, et al. Renal amyloidosis in ankylosing spondylitis: A monocentric study and review of literature[J]. Saudi Journal of Kidney Diseases & Transplantation An Official Publication of the Saudi Center for Organ Transplantation Saudi Arabia, 2018, 29(2):386.

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