动脉瘤是自体动静脉内瘘(Arteriovenous fistula, AVF)使用过程中的常见并发症,包括真性动脉瘤及假性动脉瘤,发病率从5%到60%不等,动脉瘤的感染、破裂出血、血栓可危及患者生命。本文报道1例自体动静脉内瘘严重钙化伴有感染破溃风险的真性动脉瘤处理,本中心予以左侧肱动脉修补术及左上肢动脉瘤切除术,避免了感染加重、出血等严重并发症的发生。Aneurysm is a common complication during the use of arteriovenous fistula (AVF), including true aneurysms and pseudoaneurysms, with incidence rates ranging from 5% to 60%. Aneurysm-related infections, rupture-induced hemorrhage, and thrombosis can be life-threatening. This article reports a case of severely calcified true aneurysm in an arteriovenous fistula with risk of infection and rupture. Our center performed left brachial artery repair and left upper extremity aneurysm resection, thereby preventing severe complications such as infection exacerbation and hemorrhage.
系统性红斑狼疮(SLE)是一种影响多个器官的全身性自身免疫疾病,其特点是免疫细胞、免疫因子和免疫途径的复杂相互作用导致各种临床表现。抗中性粒细胞胞浆抗体(ANCA)相关性血管炎(AAV)是一组以中小血管坏死性炎症和外周血中出现ANCA为特征的自身免疫综合征。SLE/AAV重叠综合征(overlap syndrome, OS)一种混合表现的炎症性疾病,具有SLE和AAV的临床特征。在极少数情况下,SLE和AAV同时发病表现出更严重的临床症状。缺血性结肠炎(IC)是一组存在血管闭塞性或非闭塞性疾病的临床综合征,以结肠供血不足为特征。本文报告了1例SLE/AAV OS伴随缺血性结肠炎患者。经过血浆置换、足量激素冲击、免疫抑制剂环磷酰胺和硫酸羟氯喹、抑酸药、生长激素抑制类药物等治疗后,患者病情缓解。Systemic lupus erythematosus (SLE) is a systemic autoimmune disease that affects multiple organs and is characterized by a complex interplay of immune cells, immune factors, and immune pathways leading to a variety of clinical manifestations. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) is a group of autoimmune syndromes characterized by necrotizing inflammation of small and medium-sized blood vessels and the presence of ANCA in the peripheral blood. Overlap syndrome (OS) is a mixed manifestation of inflammatory disease with clinical features of SLE and AAV. In rare cases, the concurrent onset of SLE and AAV results in SLE/AAV OS, which exhibits more severe clinical symptoms. Ischemic colitis (IC) is a group of clinical syndromes in the presence of vaso-occlusive or non-occlusive disorders characterized by inadequate blood supply to the colon. In this article, we report a patient with SLE/AAV OS combined with ischemic colitis. After treatment with adequate hormonal shocks, the immunosuppressants cyclophosphamide and hydroxychloroquine sulfate, plasma exchange, acid-suppressing drugs, and anti-growth hormone analogs,
目的:探讨血清骨唾液酸蛋白(BSP)与维持性血液透析(MHD)患者腹主动脉钙化的关系。方法:选取2016年5月至2017年2月于本院血液净化中心规律透析患者75例。检测患者血清BSP,并进行腹部侧位X平片拍摄,根据kauppila半定量积分方法进行腹主动脉钙化评分(AACs),参考CORD分段方法,根据AAC得分将患者分为无或轻度钙化组(AACs≤4)、中度钙化组(5≤AACs≤15)和重度钙化组(AACs≥16)。Logistic回归分析MHD患者AAC的影响因素。受试者工作特征(ROC)曲线分析BSP对血管钙化的诊断价值。结果:75例MHD患者中发生腹主动脉钙化者56例(74.67%),AACs中位数为4(0,24)分,血清BSP中位数为20.12(18.63,24.21)ng/ml。中度钙化组、重度钙化组BSP水平均高于无或轻度钙化组[22.43(19.58,6.84)ng/ml、21.99(19.87,26.18)ng/ml vs 19.16(17.3,23.3)ng/ml,P<0.05]。Logistic回归分析发现BSP是AAC的独立危险因素(OR=1.175,95%CI 1.004~1.375,P<0.05)。ROC曲线分析发现,BSP诊断AAC的曲线下面积为0.718(95%CI为0.604~0.833,P=0.001),BSP诊断AAC的临界值为21.51 ng/ml,灵敏度为0.711,特异度为0.595。结论:血清BSP水平和MHD患者AAC的严重程度相关,高水平的BSP是AAC的独立危险因素。BSP对MHD患者腹主动脉钙化具有潜在诊断价值。
