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透析性骨关节病的治疗

2019-03-27 阅读量:4582次
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(一)治疗

1.药物治疗非甾体解热镇痛药如双氯芬酸、布洛芬等可用于慢性透析性关节病的症状管理。这类药物主要用于缩短和减轻结晶产生的急性炎症过程。局部关节严重疼痛可考虑关节内注射类固醇,但因存在感染风险,故应严格评估适应证。小剂量口服泼尼松(强的松)(0.1mg/kg)或有助于缓解疼痛。为预防骨质疏松症,可考虑合用钙剂及活性维生素D制剂,如α-D30.25~0.5μg/d或骨化三醇(罗钙全)0.25μg/d。有陈旧性结核、乙肝、丙肝指标阳性者,为避免感染再发或恶化,通常不选用泼尼松。抑制AGE的形成(如盐酸氨胍、人参皂甙)不仅对可溶性β2-微球蛋白的AGE修饰有阻断作用,还可抑制已和胶原结合的β2-微球蛋白的原位修饰。使用可溶性AGE受体降低循环中AGE水平,起到阻断的生物学活性。提示这类药物或对透析性骨关节病的防治有所助益。

2.手术治疗腕管综合征(carpaltunnalsyndrome,CTS)通常主张早期手术,以避免造成不可逆的神经肌肉损伤,目前国外对腕管综合征及肩关节可采用内镜切除局部韧带;负重关节的破坏性关节病变可考虑关节置换术;伴有神经根压迫的脊椎移位需行融合矫形术。

3.血液净化治疗血液透析(Hemodialysis),血液透析滤过(hemodiafiltration),血液滤过(hemofiltration)分别与吸附β2-微球蛋白灌流器串联有助于清除β2-微球蛋白。

4.肾移植出现透析性骨关节病的症状,可考虑及早行肾移植术。肾移植术后,透析性骨关节病的关节症状或可得到改善,但骨、关节病变的放射学改变和淀粉样沉积可能依然存在。

(二)预后

本病的预后与病程长短及并发症的情况密切相关。也有所不同。

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2019-03-27

透析性骨关节病的检查

2019-03-27

透析性骨关节病的并发症状

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