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首页> 美国卫生研究院文献>European Heart Journal: Case Reports >Intramyocardial arteriosclerosis with calcification in a patient on haemodialysis due to diabetic nephropathy may not be related to calciphylaxis
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Intramyocardial arteriosclerosis with calcification in a patient on haemodialysis due to diabetic nephropathy may not be related to calciphylaxis

机译：由于糖尿病肾病因血液透析而患有血液透析的患者肿瘤肌动脉硬化可能与钙吡咯无关

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A 76-year-old man who had been on haemodialysis (HD) for 8 years due to diabetic nephropathy, was admitted for evaluation of asymptomatic, diffuse hypokinesis of the left ventricle (LV). Electrocardiography showed sinus rhythm, left ventricular hypertrophy (LVH), a Q wave in lead III, and a negative T wave in leads V5 and V6. Echocardiography showed LVH and diffuse hypokinesis with left ventricular ejection fraction (LVEF) 37%. Adenosine stress Tc-99m tetrofosmin cardiac scintigraphy revealed an uptake defect in the inferior wall of the LV (Supplementary material online, Figure S1) and diffuse hypokinesis of the LV with a 35% LVEF (Supplementary material online, Figure S2). Coronary angiography showed total occlusion in segment 2 of the right coronary artery. Myocardial biopsy was performed to evaluate the cause of diffuse hypokinesis of LV. A myocardial biopsy showed severe stenosis of ∼50 μm in diameter with calcification in the intramural arteriole (Figure 1), which seemed to be associated with diffuse hypokinesis of the LV because microangiopathy due to diabetes or cardiac calciphylaxis may occur microcirculatory ischaemia to hypokinesis itself or associated with inferior old myocardial infarction. Incidentally, a biopsy of his scalp had been performed to evaluate skin cancer immediately before admission. Finally, skin lesion was not cancer but seborrhoeic keratosis, and we searched arteriole in the normal skin in the biopsied specimen. And, it showed no calcification or significant stenosis in subcutaneous arterioles of the same size (Figure 2). Calciphylaxis (or calcific uraemic arteriolopathy) is a syndrome of calcification in the media of small arteries that induces stenosis, thrombosis, and skin necrosis in patients on HD. Recently, cardiac calciphylaxis has been reported in HD patients.1 The present patient had a calcified lesion of the arteriole in the myocardium, but not the skin. These findings suggested that the mechanisms of calcification of the intramural small coronary artery may be different from calciphylaxis in patients on HD.
机译：由于糖尿病肾病8年来，一名76岁的男子患有8年的血液透析（HD），被禁止评估左心室（LV）的无症状，弥漫性低管。心电图显示窦性心律，左心室肥大（LVH），铅III中的Q波，引线V5和V6中的负T波。超声心动图显示了LVH和左心室喷射分数（LVEF）37％的衍射低管。腺苷应激TC-99M Tetroofosmin心脏闪烁扫描显示LV的下壁（辅助材料在线，图S1）和LV衍射低管的摄取缺陷，35％LVEF（在线补充材料，图S2）。冠状动脉造影显示右冠状动脉段2中的总闭塞。进行心肌活检以评估LV弥漫性低管的原因。心肌活检显示直径〜50μm的严重狭窄，葡萄牙静脉曲张（图1）钙化，其似乎与LV的弥漫性低管相关，因为由于糖尿病或心脏钙肌腱引起的微盲肠病变可能发生微循环性缺血到低管本身或者与劣质性心肌梗死有关。顺便提一下，已经进行了他的头皮的活组织检查，已经进行了在入院前立即评估皮肤癌。最后，皮肤病变不是癌症，但怀孕的角化症，我们在活检标本中搜索了正常皮肤的动脉凋亡。并且，它在相同尺寸的皮下动脉中没有显示钙化或显着的狭窄（图2）。钙吡咯（或钙血糖动脉神经病症）是培养患者在高清患者中的小动脉培养基中钙化综合征。最近，在高清患者中报道了心脏钙肝.1本患者在心肌中的动脉膜的钙化病变，但不是皮肤。这些发现表明，历史型小冠状动脉的钙化机制可能与高清患者钙糊糊的不同。

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