CAJ | 학술논문

目的：分析维持性血液透析患者合并退缩人综合征的临床特点，并予积极的预防和治疗。方法选择江苏省苏北人民医院血液净化中心规律血液透析合并退缩人综合征患者4例，透析龄均在7年以上，收集患者一般资料、临床症状、身高变化、生化指标、骨密度、活性维生素D3冲击量及时间、促红细胞生成素用量。结果4例患者身高缩短均＞12 cm；且都伴有生活自理能力下降、骨关节疼痛、骨畸形；4例患者均有碱性磷酸酶明显升高、高钙血症、骨质疏松，且全段甲状旁腺激素均明显升高＞1800 pg/ml，经活性维生素D3冲击治疗无效。其中1例患者行甲状旁腺全切加前臂移植术。结论退缩人综合征形成的主要原因是难治性继发性甲状旁腺功能亢进症，防止继发性甲旁亢的发生，进行早期监测，早期治疗，合理用药，是防止退缩人综合征发生的关键。
목적：분석유지성혈액투석환자합병퇴축인종합정적림상특점，병여적겁적예방화치료。방법선택강소성소북인민의원혈액정화중심규률혈액투석합병퇴축인종합정환자4례，투석령균재7년이상，수집환자일반자료、림상증상、신고변화、생화지표、골밀도、활성유생소D3충격량급시간、촉홍세포생성소용량。결과4례환자신고축단균＞12 cm；차도반유생활자리능력하강、골관절동통、골기형；4례환자균유감성린산매명현승고、고개혈증、골질소송，차전단갑상방선격소균명현승고＞1800 pg/ml，경활성유생소D3충격치료무효。기중1례환자행갑상방선전절가전비이식술。결론퇴축인종합정형성적주요원인시난치성계발성갑상방선공능항진증，방지계발성갑방항적발생，진행조기감측，조기치료，합리용약，시방지퇴축인종합정발생적관건。
Objective:To analyze the clinical features of shrinking man syndrome in maintenance hemodialysis(MHD)Pa-tients,and to discuss the prevention and treatment of the syndrome. Methods:We recruited 4 shrinking man syndrome patients under-going hemodialysis in Blood Purfication Center of SubeiPeoples's Hospital.The hemodialysis age of the 4 patients was more than 7 years.Parameters including general status,clinical manifestations, height,biochemical examinations,bone mineral density,dose and time of active vitamin D3 pulse therapy and dose of EPO were col-lected.Results:Their body height shortened over 12 cm.All of them had decreased independent living ability,joint and bone pain,and bone deformities.All of them had higher serum ALP, hypercalcemia, osteoporosis.Serum iPTH was as high as>1800pg/ml,and was unre-sponsive to pulse administration of active vitamin D3.Conclusions:Leading to shrinking man syndrome is main reason of refractory sec-ondary hyperparathyroidism.Early detection and appropriate treat-ment of secondary hyperparathyroidism is the key to prevent the shrinking man syndrome in these patients.