透析患者の滑液包炎の臨床病理学的検討 滑液包の滑膜アミロイド沈着症:滑液包の滑膜アミロイド沈着症  [in Japanese] Clinicopathological studies of bursitis in patients on hemodialysis. Bursitis in association with synovial amyloidosis.:Bursitis in association with synovial amyloidosis  [in Japanese]

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長期血液透析患者に合併した, 滑液包炎15例の臨床病理学的検討を行った. 男性8例, 女性7例. 平均年齢54±7歳. 平均透析歴12±3年. 滑液包炎の罹患部位は, 股関節部4例, 足関節部3例, 手関節部3例, 肘関節部3例, 肩関節部1例, 膝関節部1例であった. それぞれの関節周囲部の腫脹 (腫瘤あるいは嚢腫形成) と発赤, 疼痛を訴えた. 腫脹部の超音波, CT, MRI所見では, 関節腔とは明らかに離れた滑液包の嚢腫状拡張が証明された. 発熱等の全身症状を訴える患者はいなかった. 11例が手根管症候群を合併し, 手根管開放術を施行した. 4例では罹患部近傍の骨嚢腫 (bone cyst) の所見がみられ, 3例では皮下の腫瘤形成型の石灰沈着がみられた. 滑液包の炎症細胞浸潤, 線維性結合織の肥厚がみられ, 滑膜下結合織と骨膜にβ<sub>2</sub>-MGアミロイド沈着がみられた. 滑液包と骨嚢胞の骨膜が癒着し, 骨壊死所見を認める症例もあった. 穿刺液は淡黄色, 透明, 粘稠な滑液で, カルシウム塩の結晶を認める症例もあった, 遊離細胞の電顕観察で, アミロイド線維が証明された. 一般細菌, 真菌, 結核菌の培養はいずれも陰性であった. 長期透析患者に合併した滑液包炎は, 滑膜にβ<sub>2</sub>-MGアミロイド線維の沈着を認めたことより透析アミロイド症の一つと考えられた. この滑液包炎は, 骨嚢腫や腫瘤状石灰沈着との関連性も推測された. 今後, 透析患者の訴える関節痛の中には, 滑液包炎の存在も考慮しなければならないと考えられた.

The clinical and pathological pictures of synovitis in 15 patients (8 male, 7 female) on long-term hemodialysis were studied. The average age of the patients was 54±7 years and the average period of hemodialysis was 12±3 years. They developed swelling, redness, and pain in the region of the bursa around the large joints: the hip (four patients), ankle (three), hand (three), elbow (three), and shoulder (one). The dialated bursae could be distinguished by CT and MRI findings. Eleven patients had carpal tunnel syndrome, for which a carpal tunnel release operation was done, four had bone cysts, and three had tumorous calcification. The infiltration of inflammatory cells, fibrous thickening, and β<sub>2</sub>-MG amyloid fibrils were recognized in the synovial tissues. In some cases with bone cysts, both adhesions of the synovial capsule with periosteum and bone necrosis were recognized. Fluid taken from the bursae was yellow, rather than turbid synovial fluid, and showed calcium crystals in some cases. Ultrastructurally, amyloid fibrils and free synovial cells were recognized in the synovial fluid. Culture of the fluid was negative. Based on the presence of β<sub>2</sub>-MG amyloid in synovial tissues of the bursa, this bursitis in dialysis patients is considered to be a dialysis-associated amyloidosis. The results of this report suggest that dialysis bursitis is related to bone cysts and tumorous calcification. We must, therefore, include bursitis as a possible diagnosis in patients complaining of arthralgia duruing long-term hemodialysis.

Journal

  • Journal of Japanese Society for Dialysis Therapy

    Journal of Japanese Society for Dialysis Therapy 26(3), 333-338, 1993

    The Japanese Society for Dialysis Therapy

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