PDF(Pubmed)
Abstract：
Calcific uremic arteriolopathy (CUA) is a severely morbid disease, affecting mostly dialyzed end-stage renal disease (ESRD) patients, associated with calcium deposits in the skin. Calcifications have been identified in ESRD patients without CUA, indicating that their presence is not specific to the disease. The objective of this retrospective multicenter study was to compare elastic fiber structure and skin calcifications in ESRD patients with CUA to those without CUA using innovative structural techniques. Fourteen ESRD patients with CUA were compared to 12 ESRD patients without CUA. Analyses of elastic fiber structure and skin calcifications using multiphoton microscopy followed by machine-learning analysis and field-emission scanning electron microscopy coupled with energy dispersive X-ray were performed. Elastic fibers specifically appeared fragmented in CUA. Quantitative analyses of multiphoton images showed that they were significantly straighter in ESRD patients with CUA than without CUA. Interstitial and vascular calcifications were observed in both groups of ESRD patients, but vascular calcifications specifically appeared massive and circumferential in CUA. Unlike interstitial calcifications, massive circumferential vascular calcifications and elastic fibers straightening appeared specific to CUA. The origins of such specific elastic fiber\'s alteration are still to be explored and may involve relationships with ischemic vascular or inflammatory processes.
摘要：
钙化性尿毒症小动脉病变（CUA）是一种严重病态疾病，主要影响透析终末期肾病（ESRD）患者，与皮肤中的钙沉积有关。在没有CUA的ESRD患者中已发现钙化，表明它们的存在不是该疾病特有的。这项回顾性多中心研究的目的是使用创新的结构技术比较患有CUA的ESRD患者与没有CUA的患者的弹性纤维结构和皮肤钙化。将14例有CUA的ESRD患者与12例无CUA的ESRD患者进行比较。使用多光子显微镜分析弹性纤维结构和皮肤钙化，然后进行机器学习分析和场发射扫描电子显微镜以及能量色散X射线。弹性纤维在CUA中特别出现片段化。多光子图像的定量分析表明，患有CUA的ESRD患者比没有CUA的ESRD患者明显变直。两组ESRD患者均观察到间质和血管钙化,但在CUA中特别出现了大量和环状的血管钙化。与间质钙化不同,大量环状血管钙化和弹性纤维拉直似乎是CUA特有的。这种特定弹性纤维改变的起源仍有待探索，可能与缺血性血管或炎症过程有关。
