目的:许多淀粉样变性患者在淀粉样变性诊断之前和发生心脏或其他严重疾病表现之前都会经历腕管松解术(CTR)。这项研究的目的是检查我们的患者人群是否具有与先前研究相似的淀粉样变性阳性诊断患病率,并描述实施淀粉样变性筛查计划的结果。
方法:我们回顾性回顾了2020年3月至2021年12月在CTR期间接受腱鞘活检的所有患者的活检结果和后续干预措施。使用适当的筛选算法,对符合疾病风险增加标准的患者进行淀粉样蛋白筛选。
结果:156例接受CTR的患者中有75例(48%)符合淀粉样变性检测的合格标准。在同意接受腱鞘活检的62例患者中,14个有淀粉样蛋白阳性活检标本(10名男性和4名女性)。所有腱膜活检阳性的患者均患有双侧腕管综合征和野生型甲状腺素运载蛋白淀粉样蛋白亚型。一名患者被诊断并开始治疗其他无症状的心脏淀粉样变性。
结论:使用适当性筛选算法的标准,患者CTR的淀粉样蛋白阳性腱膜活检结果的发生率为22.5%,比以前报道的要高。对接受CTR的患者实施筛查计划需要多学科方法,并且可能导致淀粉样变性患者的早期诊断和挽救生命的干预措施。
方法:鉴别诊断/症状患病率研究,II.
OBJECTIVE: Many patients with amyloidosis undergo carpal tunnel release (CTR) before amyloidosis diagnosis and before developing cardiac or other serious disease manifestations. The purposes of this study were to examine if our patient population had a similar prevalence of positive amyloidosis diagnoses to that in prior studies and to describe the results of implementing a screening program for amyloidosis.
METHODS: We retrospectively reviewed the biopsy results and subsequent interventions for all patients who underwent screening
tenosynovial biopsy during CTR from March 2020 through December 2021. Amyloid screening was offered to patients who met the criteria for increased risk of disease using an appropriateness screening algorithm.
RESULTS: Seventy-five (48%) of 156 patients who underwent CTR met the eligibility criteria for amyloidosis testing. Of the 62 patients who agreed to undergo
tenosynovial biopsy, 14 had amyloid-positive biopsy specimens (10 men and 4 women). All patients with positive
tenosynovial biopsies had bilateral carpal tunnel syndrome and wild-type transthyretin amyloid subtype. One patient was diagnosed and started treatment for otherwise asymptomatic cardiac amyloidosis.
CONCLUSIONS: The incidence of amyloid-positive
tenosynovial biopsy results from CTR was 22.5% in patients using the criteria from an appropriateness screening algorithm, which was higher than previously reported. Implementation of a screening program for patients undergoing CTR requires a multidisciplinary approach and may result in early diagnosis and lifesaving interventions for patients with amyloidosis.
METHODS: Differential diagnosis/symptom prevalence study, II.