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Abstract：
Background/Objectives: To determine the prevalence of amyloidosis through the analysis of synovial tissue and transverse carpal ligament (TCL) in patients undergoing surgery for carpal tunnel syndrome (CTS), detect predictive factors for the presence of amyloid, and assess cardiac involvement degree. Methods: A prospective study with longitudinal cohort follow-up at a teaching hospital. Patients undergoing CTS surgery from 1 January 2019 to 31 May 2021 were included. Samples from synovial and TCL tissues were examined for amyloid presence. Multivariate analysis was used to detect predictive factors of the presence of amyloid. Patients with amyloid underwent echocardiography, laboratory analyses, and scintigraphy. Results: Two hundred and forty-six patients were included. The prevalence of amyloid was 11.4% in TCL and 12.6% in synovial tissues. Age (p = 0.035; OR 1.123), bilateral CTS symptoms (p = 0.022; OR 3.647), and trigger finger (p < 0.001; OR 3.537) were predictors of the presence of amyloid. Seventeen patients were diagnosed with transthyretin amyloidosis (ATTR) located in the carpus (no scintigraphic cardiac uptake or grade 0), one with light chain amyloidosis, eight with ATTR with cardiac involvement (grades 2-3), and five with ATTR in the carpus and scintigraphic uptake grade 1 (with normal echocardiogram and blood and urine tests). Conclusions: We detected amyloid in 12.6% of unselected consecutive patients who underwent CTS surgery. Biopsy in patients with CTS for amyloid detection, especially in elderly patients with bilateral symptoms and trigger finger, may be useful for the early diagnosis of amyloidosis, primarily due to transthyretin.
摘要：
背景/目的：通过分析腕管综合征（CTS）手术患者的滑膜组织和腕横韧带（TCL），确定淀粉样变性的患病率。检测淀粉样蛋白存在的预测因素，评估心脏受累程度。方法：在教学医院进行纵向队列随访的前瞻性研究。包括2019年1月1日至2021年5月31日接受CTS手术的患者。检查来自滑膜和TCL组织的样品的淀粉样蛋白存在。多因素分析用于检测淀粉样蛋白存在的预测因素。淀粉样蛋白患者接受超声心动图检查，实验室分析,和闪烁显像术。结果：纳入了二百四十六例患者。淀粉样蛋白在TCL和滑膜组织中的患病率分别为11.4%和12.6%。年龄（p=0.035；OR1.123），双侧CTS症状（p=0.022；OR3.647），和触发手指(p<0.001;OR3.537)是淀粉样蛋白存在的预测因子。17例患者被诊断为位于腕部的甲状腺素运载蛋白淀粉样变性（ATTR）（无闪烁显像心脏摄取或0级），一个有轻链淀粉样变性，8例ATTR伴心脏受累（2-3级），心脏和闪烁显像摄取1级（超声心动图正常，血液和尿液检查）中有5例ATTR。结论：我们在接受CTS手术的未选择的连续患者中检测到12.6％的淀粉样蛋白。对CTS患者进行活检以检测淀粉样蛋白，尤其是有双侧症状和触发手指的老年患者，可能对淀粉样变性的早期诊断有用，主要是由于运甲状腺素。
