目的观察罗沙司他治疗重组人促红细胞生成素(recombinant human erythropoietin,rHuEPO)治疗效果不佳的钙化防御透析患者肾性贫血的疗效和安全性。方法本研究为前瞻性队列研究,筛选2019年1月1日至2021年3月28日期间于东南大学附属中大...目的观察罗沙司他治疗重组人促红细胞生成素(recombinant human erythropoietin,rHuEPO)治疗效果不佳的钙化防御透析患者肾性贫血的疗效和安全性。方法本研究为前瞻性队列研究,筛选2019年1月1日至2021年3月28日期间于东南大学附属中大医院肾内科确诊钙化防御且既往规律使用rHuEPO≥3个月血红蛋白(hemoglobin,Hb)仍未达标(Hb<110 g/L)的透析患者。采用自身前后对照,分析口服罗沙司他对钙化防御透析患者肾性贫血的疗效。结果本研究共纳入钙化防御合并肾性贫血透析患者18例,年龄(49.7±16.2)岁,其中男性11例,女性7例,血液透析14例,腹膜透析4例。入组时所有患者超敏C反应蛋白(参考值0~3 mg/L)为27.3(15.6,48.5)mg/L。基线Hb为(85.4±11.6)g/L,口服罗沙司他3个月时Hb为(105.8±15.2)g/L,较前显著升高,差异有统计学意义(t=-9.282,P<0.001)。Hb达标率为44.4%(8/18)。使用罗沙司他治疗3个月铁蛋白水平较基线值下降[208.0(59.0,306.3)μg/L比229.0(127.3,385.2)μg/L,Z=-3.637,P<0.001],总铁结合力水平较基线值上升[127.0(65.0,211.5)μmol/L比105.5(43.8,153.7)μmol/L,Z=-2.156,P=0.031],转铁蛋白饱和度水平较基线水平轻度下降[20.2%(14.2%,27.7%)比20.5%(18.7%,34.9%),Z=-1.546,P=0.122],但差异无统计学意义。所有患者用药期间无不良反应发生。结论罗沙司他能有效纠正炎症状态下钙化防御合并肾性贫血透析患者的Hb水平,改善铁代谢,安全性高。展开更多
BACKGROUND Calciphylaxis is a form of vascular calcification more commonly associated with renal disease. While the exact mechanism of calciphylaxis is poorly understood,most cases are due to end stage kidney disease....BACKGROUND Calciphylaxis is a form of vascular calcification more commonly associated with renal disease. While the exact mechanism of calciphylaxis is poorly understood,most cases are due to end stage kidney disease. However, it can also be found in patients without kidney disease and in such cases is termed non-uremic calciphylaxis for which have multiple proposed etiologies.CASE SUMMARY We describe a case of a thirty-year-old morbidly obese Caucasian female who had a positive history of alcoholic hepatitis and presented with painful calciphylaxis wounds of the abdomen, hips, and thighs. The hypercoagulability panel showed low levels of Protein C and normal Protein S, low Antithrombin Ⅲ and positive lupus anticoagulant and negative anticardiolipin. Wound biopsy confirmed the diagnosis of non-uremic calciphylaxis in the setting of alcoholic liver disease. The calciphylaxis wounds did not improve when Sodium Thiosulfate was used alone. The patient underwent a series of bedside and surgical debridement. Broad spectrum antibiotics were also used for secondary wound bacterial infections. The patient passed away shortly after due to sepsis and multiorgan failure.CONCLUSION Non-uremic Calciphylaxis can occur in the setting of alcoholic liver disease. The treatment of choice is still unknown.展开更多
Calcific uremic arteriolopathy (CUA) is a rare pathology affecting 5% of dialysis patients but with a poor prognosis. It is characterized by calcification and thrombotic lesions of the microcirculation leading to hype...Calcific uremic arteriolopathy (CUA) is a rare pathology affecting 5% of dialysis patients but with a poor prognosis. It is characterized by calcification and thrombotic lesions of the microcirculation leading to hyperalgesic ischemic skin lesions. Several risk factors have been identified, mainly warfarin treatment, mineral and bone disorders (MBD), inflammation and malnutrition. In the evocative forms, the diagnosis is made based upon the physical examination finding of classic painful ulcerated lesions that are covered by a black eschar. Skin biopsy, due to the risk of aggravation and delayed healing, is only performed in case of doubt diagnosis. The therapeutic attitude due to the lack of solid randomized studies is based on expert consensus and requires a multidisciplinary approach. We report here the case of a patient with CUA revealed in the form of multiple ulcerative-necrotic skin lesions associated with pressure sores and arterial wounds.展开更多
文摘目的观察罗沙司他治疗重组人促红细胞生成素(recombinant human erythropoietin,rHuEPO)治疗效果不佳的钙化防御透析患者肾性贫血的疗效和安全性。方法本研究为前瞻性队列研究,筛选2019年1月1日至2021年3月28日期间于东南大学附属中大医院肾内科确诊钙化防御且既往规律使用rHuEPO≥3个月血红蛋白(hemoglobin,Hb)仍未达标(Hb<110 g/L)的透析患者。采用自身前后对照,分析口服罗沙司他对钙化防御透析患者肾性贫血的疗效。结果本研究共纳入钙化防御合并肾性贫血透析患者18例,年龄(49.7±16.2)岁,其中男性11例,女性7例,血液透析14例,腹膜透析4例。入组时所有患者超敏C反应蛋白(参考值0~3 mg/L)为27.3(15.6,48.5)mg/L。基线Hb为(85.4±11.6)g/L,口服罗沙司他3个月时Hb为(105.8±15.2)g/L,较前显著升高,差异有统计学意义(t=-9.282,P<0.001)。Hb达标率为44.4%(8/18)。使用罗沙司他治疗3个月铁蛋白水平较基线值下降[208.0(59.0,306.3)μg/L比229.0(127.3,385.2)μg/L,Z=-3.637,P<0.001],总铁结合力水平较基线值上升[127.0(65.0,211.5)μmol/L比105.5(43.8,153.7)μmol/L,Z=-2.156,P=0.031],转铁蛋白饱和度水平较基线水平轻度下降[20.2%(14.2%,27.7%)比20.5%(18.7%,34.9%),Z=-1.546,P=0.122],但差异无统计学意义。所有患者用药期间无不良反应发生。结论罗沙司他能有效纠正炎症状态下钙化防御合并肾性贫血透析患者的Hb水平,改善铁代谢,安全性高。
文摘BACKGROUND Calciphylaxis is a form of vascular calcification more commonly associated with renal disease. While the exact mechanism of calciphylaxis is poorly understood,most cases are due to end stage kidney disease. However, it can also be found in patients without kidney disease and in such cases is termed non-uremic calciphylaxis for which have multiple proposed etiologies.CASE SUMMARY We describe a case of a thirty-year-old morbidly obese Caucasian female who had a positive history of alcoholic hepatitis and presented with painful calciphylaxis wounds of the abdomen, hips, and thighs. The hypercoagulability panel showed low levels of Protein C and normal Protein S, low Antithrombin Ⅲ and positive lupus anticoagulant and negative anticardiolipin. Wound biopsy confirmed the diagnosis of non-uremic calciphylaxis in the setting of alcoholic liver disease. The calciphylaxis wounds did not improve when Sodium Thiosulfate was used alone. The patient underwent a series of bedside and surgical debridement. Broad spectrum antibiotics were also used for secondary wound bacterial infections. The patient passed away shortly after due to sepsis and multiorgan failure.CONCLUSION Non-uremic Calciphylaxis can occur in the setting of alcoholic liver disease. The treatment of choice is still unknown.
文摘Calcific uremic arteriolopathy (CUA) is a rare pathology affecting 5% of dialysis patients but with a poor prognosis. It is characterized by calcification and thrombotic lesions of the microcirculation leading to hyperalgesic ischemic skin lesions. Several risk factors have been identified, mainly warfarin treatment, mineral and bone disorders (MBD), inflammation and malnutrition. In the evocative forms, the diagnosis is made based upon the physical examination finding of classic painful ulcerated lesions that are covered by a black eschar. Skin biopsy, due to the risk of aggravation and delayed healing, is only performed in case of doubt diagnosis. The therapeutic attitude due to the lack of solid randomized studies is based on expert consensus and requires a multidisciplinary approach. We report here the case of a patient with CUA revealed in the form of multiple ulcerative-necrotic skin lesions associated with pressure sores and arterial wounds.
