臨牀透析 Vol.20 No.2(1)


特集名 透析アミロイド症 -- 今日の考え方
題名 透析アミロイド症とは
発刊年月 2004年 02月
著者 高橋 直生 新潟大学大学院医歯学総合研究科内部環境医学講座 (第二内科) / 厚生連長岡中央綜合病院内科
著者 殷 煕安 厚生連長岡中央綜合病院内科
著者 下条 文武 新潟大学大学院医歯学総合研究科内部環境医学講座 (第二内科)
【 要旨 】 アミロイド症は,異なった種々の背景の結果として,細胞外領域にアミロイド線維が沈着する一連の疾患群である.透析アミロイド症は,長期の透析療法の結果,腱・骨・滑膜などにアミロイド線維が沈着し,患者のADLを著しく損ねる原因になっている.1985年,Gejyoらにより,透析アミロイド線維の前駆蛋白質が,beta2-microglobulinであることが同定され,以後,透析アミロイド症研究が盛んになった.しかし,その病態の詳細は依然として不明な点が多い.本稿では,透析アミロイド症の研究の推移,疫学,危険因子,他のアミロイド症との共通性や特異性について概説するとともに,beta2-microglobulinの特徴,役割,体内動態についても言及した.
Theme Dialysis Amyloidosis -- Present State of the Art
Title Dialysis-related amyloidosis
Author Naoki Takahashi Department of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences / Department of Internal Medicine, Koseiren Nagaoka Chuo General Hospital
Author Hian Inn Department of Internal Medicine, Koseiren Nagaoka Chuo General Hospital
Author Fumitake Gejyo Department of Clinical Nephrology and Rheumatology, Niigata University Graduate School of Medical and Dental Sciences
[ Summary ] Amyloidosis is a group of precursor protein misfolding diseases characterized by the pathological deposition in extracellular spaces with insoluble fibrils. Dialysis-related amyloidosis (DRA) is a common, serious complication in patients receiving long-term dialysis. DRA is regarded as one of the systemic forms of amyloidosis because of the deposits made in the chorda, bone, synovia, heart, or skin. The most common manifestations are carpal tunnel syndrome, bone cysts, and destructive spondyloarthropathy. Since Gejyo displayed, in 1985, that beta2-microglobulin (beta2-m) was a major structural component of DRA fibrils, many investigators have reported studies on DRA. Although the structural stability of beta2-m may help in understanding the molecular bases of DRA fibril formation, the detailed mechanism is still obscure. In this paper, we described an outline of the study for DRA, epidemiology, risk factors, commonality compared with other forms of amyloidosis and specificity. In addition, we also mentioned a characteristic of beta2-m, it's role, in the kinetics of the body.
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