body pain
Introduction
Introduction The classification of painful parts can be divided into three categories: physical pain, visceral pain, and heart pain. However, multiple pains generally refer to physical symptoms of limbs and multiple parts of the trunk. This type of division is wide and varies in degree, and pain of varying nature is also called a body pain. Suffering from multiple pains, mostly due to systemic diseases, but local lesions should not be ignored.
Cause
Cause
Etiology classification
(A) the cause of multiple muscle pain 1 fatigue myalgia. 2 viral myalgia. 3 acute infectious disease myalgia. 4 types of rheumatism and rheumatic myalgia. 5 Myalgia caused by immunoreactive diseases such as polymyositis and dermatomyositis. 6 toxic myalgia. 7 hereditary muscle disorders such as glycogen storage disease myalgia. 8 endocrine dysfunction such as diabetic amyotrophic myalgia. 2 muscle spasm, hand and foot spasm.
(B) the cause of polyarticular pain
1 Infectious joint disease: such as brucellosis, tuberculous joint disease, etc., this infectious joint disease can be caused by bacterial infection, or can be caused by mycoplasma infection caused by mycoplasmal arthritis. Viral infections can also produce infectious joint disease, such as rubella arthritis, sexually transmitted arthritis, joint syphilis produced by the stimulation of treponema toxin. 2 post-infection joint disease: such as multi-joint pain caused by Salmonella infection, but not due to the presence of bacteria in the joints to produce joint lesions. 3 metabolic joint diseases: such as articular cartilage calcinosis, gout, hemochromatosis and so on. 4 allergic reactions and immunoreactive joint diseases: such as rheumatoid arthritis, serum arthritis, drug-induced arthritis. 5 mechanical and degenerative joint diseases: such as excessive activity syndrome, acute traumatic arthritis, osteoarthritis and so on. 6 idiopathic joint pain: such as pigmented villonodular synovitis, intermittent arthritis.
(C) the causes of multiple bone pain: 1 endocrine dysfunction: such as menopausal women with osteoporosis, thyroid and parathyroid hyperfunction, Cushing's syndrome can lead to bone changes, resulting in multiple Symptoms of bone pain. 2 multiple myeloma, multiple bone metastases; can produce multiple parts of bone pain symptoms. 3 nutritional metabolic dysfunction diseases: such as osteomalacia, scurvy and so on. 4 toxic bone pain; such as vomiting poisoning, vitamin A poisoning, fluorosis and so on.
mechanism
In the clinic, "pain" is a very common and important symptom. It is caused by a variety of noxious stimuli. Pain is a subjective feeling in the body. When any part of the sensory system is stimulated by the lesion, Pain. The sensory receptor is a transducer of noxious stimulation signals. The basic conditions of painful pathophysiological processes are pain receptors, peripheral nerves of pain conduction, transmitted bundles of pain, painful subcortical centers, and pain. High-level center. There are three kinds of pain receptors in the human body: 1 superficial pain receptor. 2 deep pain receptors. 3 visceral pain receptors. The distribution density of these receptors varies with organs, tissues and parts. Deep pain receptors are mostly distributed in sarcolemma. , joint capsule, ligament, periosteum; muscle, muscle, vascular wall, etc. Mechanical stress such as pressure, tension can cause severe pain of the bone, hematoma at the end of the fracture can stimulate the periosteum to cause acute pain of the bone, acute suppuration Sexual osteomyelitis can be hyperemia due to local vasodilatation, local tissue exudate tissue pressure rises, stimulating deep receptors Produces pain.
Intramuscular deep pain receptors can cause pain from changes in intramuscular pressure, hypoxia in muscle tissue, and physical and chemical stimuli. Increased lactic acid and histamine in the muscle tissue can cause muscle soreness, and severe muscle contraction caused by various causes can cause extensive deep sore muscles. The ligaments of the ligaments and muscles are Golgi, Vatter-Paccini sacs, etc., which are sensitive to stimuli such as pulling, striking, and tension. Local chronic inflammatory stimuli can cause long-term pain.
When the blood vessels are stimulated, it can cause paralysis. The supplied muscle tissue produces ischemic pain, pain in the myeloid joints and knee joints, and pain caused by an increase in intraosseous pressure caused by changes in blood flow in the bone.
The fibrous layer of the joint capsule is rich in body stem nerve fibers and proprioceptive fibers, which are sensitive to pain and deep sensation, while the synovial tissue has less nerve distribution, and the articular cartilage has no nerve distribution. The joint pain is mainly distributed on the joint capsule and ligament. The deep pain receptors play a major role.
Examine
an examination
Related inspection
Serum immunoglobulin M (IgM) serum immunoglobulin (Ig) anti-epidemic hemorrhagic fever virus antibody (EHF-AB) serum complement C7 content alanine aminotransferase (ALT)
In the diagnosis of multiple pain as the main symptom of the disease, you must rely on the patient for other symptoms, combined with detailed physical examination and necessary laboratory tests, through analysis and selective use of some decisive auxiliary laboratory tests, And a variety of other specific examination methods, according to the results of the examination can be roughly diagnosed.
First, medical history
First of all, we must understand the duration of pain, the nature of pain, and the presence of predisposing factors, because many pains or increased pain can have obvious inducing conditions and factors. Such as functional pain in the tide, wet, cool environment is prone to attack: ligament injury and inflammation in a certain position, the pain is significantly worse. While observing multiple pain symptoms, pay attention to whether there are symptoms associated with it. Each painful disease is accompanied by various degrees of accompanying symptoms. Mastering these accompanying symptoms and degree is very important in diagnosis, which can limit the diagnosis to A certain type of disease or a disease. It is essential to collect medical history and consultation. This is the first step to understand the condition, to confirm the diagnosis and differential diagnosis, and to inform the direction of the examination and to find the source of the disease.
Second, physical examination
For diseases with multiple pain symptoms, the physical examination can not only be limited to the examination of the pain site, but a comprehensive examination is required. The first examination is to be performed, and the visual examination of the pain site is performed under full exposure. Observe whether there is swelling in the pain area, whether the skin color has changed, and whether the local blood vessels are angry. With or without muscle atrophy. Local palpation to find tender points, evoked points, analysis of pain depth, extent, degree and relationship between adjacent tissues and pain and skin temperature, muscle tension and muscle strength are normal, exercise examination is the limbs examined by active and passive activities Whether the functions of the posterior trunk, joints, muscles, muscles, and blood vessels are normal. By checking the correct record of the scope of the activity, the degree, etc. Exercise examination is a difficult method to grasp in the differential diagnosis of pain, and it is also the examination method with the widest knowledge and the most error-prone. Therefore, for each exercise, we must understand in detail the mechanism of exercise, which muscles participate in this exercise and the inner nerves. During the diagnosis of multiple pains, the measurement is used as an auxiliary test, which mainly includes blood pressure. Measurement of body temperature, weight, and limbs.
Third, laboratory inspection
For a number of painful diseases, a number of laboratory tests must be performed to obtain a diagnosis basis. For multiple pains caused by bone, bone minerals should be measured to understand changes in serum calcium and phosphorus. For pain caused by osteoporosis. In addition to the above examination and examination of alkaline phosphatase, osteocalcin can also be measured. Osteocalcin is a sensitive indicator for measuring bone turnover and has a special marker in bone formation. Suspected multiple myeloma can check bone marrow, plasma protein, urine protein (this week, protein people have multiple pains caused by muscle lesions, enzyme system check is necessary, such as aspartate aminotransferase, creatine phosphokinase, aldehyde The enzymes, etc., are commonly used for examinations and culture methods for multiple pains caused by infectious diseases, blood tests, and immune reactions.
In summary, laboratory tests are essential in the diagnosis of painful diseases and are an important part of the overall diagnostic system. Check items should be based on the actual needs of the clinic, targeted selection, to avoid blind abuse. For example, blood routine can help identify infectious and non-infectious pain diseases, and can help determine the severity and activity of rheumatoid arthritis. ESR is the most commonly used to observe rheumatic fever and tuberculosis for activity and treatment. One of the indicators, to determine whether the body has inflammation and inflammation type, in patients with pain associated with a mass, commonly used ESR to determine the nature of the mass. It can also be judged that some pain is a functional or organic disease; plasma uric acid determination has a unique diagnostic value for pain caused by gout; multi-site pain caused by tumor should be checked for alkaline and acid phosphatase human reactive protein and anti- Streptococcal hemolysin "O", rheumatoid factor agglutination test, etc. are items that require multiple tests for pain.
Fourth, radionuclide bone imaging examination, EMG examination
1. Radionuclide bone imaging is also a means of diagnosing bone pain, because bone imaging is a physiological and biochemical process that reflects bone metabolism, and when this process has not caused changes in bone structure and shape, bone scan can be It is shown, and the X-ray examination can only be detected when the density of the bone structure changes. Therefore, the early diagnosis of bone diseases has unique advantages.
2. Electromyography MGX is to judge the neuromuscular function state by examining the bioelectricity of the neuromuscular unit activity. Can be used to help diagnose multiple pains caused by muscle lesions.
Fifth, imaging examination
Imaging studies play an important role in the diagnosis of painful diseases. Since the 1980s, medical imaging diagnostic techniques have developed rapidly, and a variety of modern medical imaging devices have been introduced and widely used in clinical practice. The following are commonly used.
(1) X-ray film
X-ray plain film is usually used as one of the preliminary examination methods for imaging diagnosis. For most bone and joint diseases, qualitative, quantitative and localized diagnosis can be made based on the performance of plain film. However, the disadvantage of plain film is that it can not dynamically observe the function of the organ. The plain film is also the main examination method for the spine, limb bone and joint system.
(2) Computerized tomography (CT)
The imaging principle of CT is different from general X-ray photography. It does not rely on tissue or organ to absorb X-ray differences, but the film is different in intensity and thus produces black and white images. CT uses a detector instead of film, and its sensitivity is greatly improved. During photography, a certain X-ray beam or fan-shaped X-ray is used to scan a certain part of the body in the future. The absorption coefficient of the thin layer structure on the X-ray is continuously calculated by an electronic computer, and then the micro-absorption difference of the tissue is displayed by the signal conversion device. Different tissues and diseased structures are used to diagnose and differentially diagnose multiple diseases.
CT is a commonly used method for pain in the spine of the extremities. CT scans of the extremities and spine are mainly transverse scans, so the cross-sectional anatomy of different parts should be very familiar, that is, the anatomical concept of the cross-section should be established, and the longitudinal section and the cross-section anatomy of different axes should be separately analyzed to distinguish the difference between normal and disease. .
(3) Magnetic resonance (MR)
The emergence of magnetic resonance is another development of medical imaging after CT. Magnetic resonance (MR), formerly known as nuclear magnetic resonance (MRI), is a new type of magnetic resonance (MR) magnetic resonance (MR) in order to prevent people from misunderstanding the nuclear damage of the system. The clinical application of the diagnostic method shows that magnetic resonance is an effective and widely used advanced imaging technique. It has unique advantages in neurological disorders and is more unique than CT in many respects. Multiple pains, especially MR examinations of bone diseases, are the most valuable imaging tests. MR makes it possible for the whole body's muscle condition and bone disease to be discovered without significant clinical manifestations. Normal muscles not only have a uniform gray signal on the T1-; dynamic-weight spin echo image, but also a uniform gray signal on the proton density image and the T2 dynamic image. The diagnosis and differential diagnosis of limb muscle disease mainly changes from uniform or non-uniformity and symmetry or asymmetry.
1, type I systemic muscle changes, seen in the following diseases: 1 early myositis; 2 neuromuscular atrophy; 3 alcoholic myopathy; 4 diabetic myopathy; 5 cortisone myopathy; 6 ischemic muscle Disease; 7 mitochondrial myopathy; 8 uremic myopathy; 9 years old.
2, type II all muscle groups extensive steatosis, seen in: 1 late Duchenne muscular dystrophy; 2 terminal myositis; 3 bilateral polio.
3. Type III non-uniform symmetry lesions. Seen in: 1 tape muscular dystrophy and advanced myositis; 2 Pompe myopathy (neuromuscular degeneration) 3 central nuclear myopathy; 4 familial hypokalemia.
4. Type asymmetry non-uniformity changes. Seen in: 1 polio; 2 trauma, bleeding, disuse atrophy; 3 tumors.
MR has shown its advanced nature in the examination of brain and spinal lesions and joint diseases. accuracy. It is an indispensable method of examination in diagnosis and differential diagnosis.
Diagnosis
Differential diagnosis
(a) dermatomyositis and polymyositis
The disease mainly affects muscles and skin. Its onset may be related to cancer and infection. The age of onset of patients is mostly between 10 and 50 years old, but it is more common in young people. The prevalence of women is about twice as high as that of men. Muscle symptoms and skin damage can occur at the same time. However, some patients have mild skin damage, even no skin changes, but the muscle damage is extensive and serious. This condition is generally called "polymyositis."
Muscle inflammation, degeneration, and degeneration are the main symptoms of this disease. Any muscle can be affected, and the proximal muscles are often damaged first, especially the proximal limbs, and then other muscles are involved. Initial symptoms, multiple parts of muscle pain, and tenderness, muscle weakness, weakness and weakness. The patient's actions are difficult to move, and serious people get up and turn over is also a problem. The diseased muscle is soft at first, then hard, and finally loses weight and shrinks.
The laboratory examined patients with increased erythrocyte sedimentation rate and reduced serum total protein and albumin. The determination of creatine in 24 h urine often reaches 300-1200 mg or higher, and the aspartate aminotransferase increases significantly during disease activity.
The main diagnosis of this disease is: multiple parts of muscle pain, weakness, and tenderness, skin lesions, irregular fever and uric aciduria. When the disease is re-stained, it may be helpful to help muscle biopsy.
(two) rheumatic and rheumatoid arthritis
1. Rheumatoid arthritis: related to group A hemolytic streptococcal infection, it is currently believed that the relationship between rheumatoid arthritis and streptococcus is an allergic reaction or an allergic reaction. It is known immunologically that streptococci and their metabolites have high antigenicity and specificity, and antigens and antibodies can infiltrate connective tissues from the blood, causing such tissues to degenerate and dissolve. There is edema in the synovial membrane and surrounding tissues, fibrin and granulocyte exudation in the joint fluid, and no joint deformity occurs after the active period. Typical rheumatoid arthritis is migratory polyarthritis. From one joint to another, it is often symmetrically involved in the knee, ankle, shoulder, and wrist. Elbow, marrow and other large joints; local red, pain, heat inflammation, but not purulent, some patients with multiple joints at the same time, increased erythrocyte sedimentation rate, anti-streptolysin "O" agglutination titer increased, activity The positive C-reactive protein and the increase of serum hyaluronidase were used as the test basis. This disease is more sensitive to salicylic drugs.
2, rheumatoid arthritis (also known as atrophic arthritis): is a cause of undetermined, with polyarthritis, chronic systemic disease. All tissues that make up the joints, such as the synovium, cartilage, ligaments, muscles, and bones, have lesions. Most of the patients develop pain and stiffness from one joint. As the disease progresses, the affected joints increase, the joints enlarge, and there is heat and red. Active or passive active joints can cause pain. The involvement of the joints often starts from the distal small joints of the extremities, and may involve other joints. The proximal interphalangeal joints are most common, often with a fusiform enlargement, followed by the metacarpophalangeal, toe, wrist, knee, elbow, and ankle. Shoulder and joints. The muscles near the joints gradually shrink due to swelling and pain in the joints and movement. Even after the acute inflammation disappeared, due to the fibrous tissue proliferation in the joint, the tissue around the joint became tough and deformed, and the joint function was significantly affected. Patients were often accompanied by anemia, weight loss, subcutaneous nodules, splenomegaly, and conjunctivitis. Scleritis and so on. The test examined the erythrocyte sedimentation rate and was positive for rheumatoid factor. In the early stage of X-ray examination, only soft tissue swelling occurred, and later osteoporosis and joint space narrowed. Joint bone destruction, joint deformity and bony rigidity can occur.
(C) non-arthritic rheumatoid syndrome
Non-arthritic rheumatoid syndrome is also known as rheumatoid polymyalgia, rheumatoid myositis and the like. The cause of this disease is unknown. Some scholars believe that it has a certain relationship with autoimmunity, and may also be a systemic vascular disease. The disease occurs in female patients after menopause. Most of the history of cold, overwork and infection is acute. The patient feels pain, stiffness and inflexibility in the muscles of the neck, shoulders, back, waist, buttocks and thighs. The symptoms in the morning are obvious and there is a slight improvement after the activity. Aggravated by cold, dampness and bad mood. Patients often complain of body aches, discomfort, and stiffness. There may be a lack of appetite, fatigue and weakness, and weight loss. Low fever, night sweats, and symptoms of arteritis. Involved muscle tenderness, the muscles of the elderly can shrink. But there are no signs and symptoms of arthritis or synovitis. Laboratory tests may have increased erythrocyte sedimentation rate, elevated globulin, relative decrease in albumin, decreased serum iron, elevated serum copper, rheumatoid factor and anti-nuclear antibody-negative human-reactive protein, but some patients have normal tests. .
(4) Infectious diseases
Multiple pains are common in the prodromal and febrile phases of the acute infectious and parasitic diseases, as well as in the chronic phase. Some bacterial diseases appear as complications in the later stages of infection, such as: joint disease after bacterial dysentery, arthritis after Salmonella. There are many diseases caused by bacteria, viruses and parasitic infections. In addition to their unique clinical symptoms and signs, the symptoms of multiple pains may exist or even be obvious. The diagnosis of these diseases should be comprehensively examined and comprehensively analyzed. Finally, a diagnosis is made.
1. Influenza: This disease is an acute respiratory infection caused by influenza virus. Its clinical features are acute onset, systemic symptoms with the most obvious symptoms of poisoning, accompanied by fever, body muscle aches, headache, fatigue. According to epidemiological conditions, exposure history and collective morbidity, typical symptoms and signs are not difficult to make a diagnosis.
2, epidemic chest pain; Coxsackie virus B group can cause this disease. Mainly manifested as fever and paroxysmal myalgia, myalgia can affect the muscles of the body, and the most common in the chest and abdomen, especially the saphenous muscle is most susceptible. Myalgia is of varying severity, and even severe cases cause shock. When the muscles are active, the pain is intensified. Most of the muscle pain gradually disappears after 3-4 days, and the disease can heal itself.
3, Brucellosis: This disease can cause muscle soreness, joint swelling, joint exudate, dip and multiple joints, of which knee joint, myeloid joint, posterior joint is the most common. In the late or recovery period, osteomyelitis of the spine, limb bones, femur, ribs, etc., depending on the type of fever, laboratory examination, it is not difficult to establish a diagnosis.
4, epidemic hemorrhagic fever, leptospirosis, anterior horn polio, human trichinosis and other diseases, can have multiple pain symptoms, according to a variety of causes of the characteristic symptoms and signs after the disease, combined with experiments A room check can make a diagnosis. The key is to think about the possibility of these diseases, and then rule out one by one, and finally make a correct diagnosis.
(5) Osteoporosis
A common symptom of osteoporosis is multiple pains, so osteoporosis should be thought of when diagnosing multiple pains. The cause is not well understood. The known causes are age aging, decreased estrogen levels, and regulation of calcium endocrine balance disorders. According to the epidemiological survey, the prevalence of menopausal women in the elderly population is increasing year by year, which has caused concern and attention to the disease in the medical and social fields. Because of osteoporosis, lack of bone strength, Therefore, it is easy to produce fractures. X-ray examination of the imaging technique can have multiple vertebral compression fractures. Multiple vertebral bodies have a biconcave shape change, and some have a fence-like change in the early stage. The density of the bone is reduced, and the trabecular bone is slender and reduced. The cortical bone is thin. However, the conventional X-ray examination method must be found when the bone loss exceeds 20%-30% or more, or when a pathological fracture occurs.
Single photon bone density meter, two-photon bone density meter, can measure bone mass, in addition to qualitative effects, there is still a quantitative effect. Dual-energy X-ray absorptiometry bone density meter, X-ray instead of radionuclide, accurate measurement, high resolution, short scanning time, not only qualitative, but also quantitative. Then check the 24h urinary calcium measurement, the bone loss, the ratio increased. The determination of osteocalcin, the serum glaxin (osteocalein), is a new marker of osteoporosis, which plays an important role in bone calcification. According to the above detection method, a correct diagnosis of osteoporosis can be made.
(6) Osteomalacia
Osteomalacia is characterized by poor bone calcification and increased bone-like tissue, which leads to bone softening. The cause of this disease is that the catabolism and anabolism of bone are carried out according to normal rules, but the bone-like tissue produced cannot be calcified and ossified, so the bone becomes soft and the strength is reduced. Most of the reasons are vitamin D in food and lack of minerals and proteins such as calcium and phosphorus. It can also be caused by intestinal diseases, liver and pancreatic diseases, and long-term use of anticonvulsant drugs. The common early symptoms of this disease are extensive spontaneous pain and tenderness of the bones, the most significant pain in the lower back and lower extremities, muscle weakness, and a few Patients can have hand and foot convulsions, enter the middle and late stage, due to weight bearing various pressure deformities. X-ray findings: the disease has three characteristics that is extensive osteoporosis, pressure deformity; Looser line appears. Transverse bone trabeculae disappear Longitudinal trabecular slender, thin cortical bone, due to soft bone, spinal curvature and scoliosis, the middle part of the vertebral body is compressed, showing a double lens shape, and the intervertebral disc is relatively enlarged, so it is also called the fish vertebra. The lower limb can produce the marrow Inversion, knee varus, knee valgus, pelvic deformation, myeloid retraction, pelvic population is triangular. Laboratory tests: lower blood calcium, phosphorus and alkaline phosphatase.
(7) Hyperparathyroidism
The endocrine system is an important part of the human body to mediate the physiological activities of the body, which directly affects the growth and metabolism of the body. Endocrine diseases can occur when certain endocrine glands are dysfunctional, and certain endocrine diseases can affect changes in the skeletal system. Hyperparathyroidism is an endocrine disorder that often affects bone. The incidence can be divided into two cases, one of which is due to parathyroid adenoma, hypertrophy or adenocarcinoma caused by excessive secretion of parathyroid hormone. The second is caused by hypercalcemia or hyperphosphatemia in the body to stimulate the parathyroid glands, more common in severe kidney disease, rickets, osteolytic patients and pregnant or lactating women. The main lesions were osteoclasts, osteoblasts increased, bone resorption, calcified bone was significantly reduced, and connective tissue hyperplasia caused systemic fibrotic osteitis. The skeletal system symptoms of this disease are multiple bone pains at the beginning, which can be located in the back, spine and limbs, local tenderness, and can not support weight, which is caused by bone resorption and fibrositis. X-ray manifestations of decalcification of the bone, subperiosteal bone absorption, may vary in size, multiple or single cystic light-transmissive areas and bone softening and deformity and fracture. X-ray findings should be differentiated from osteomalacia, osteofibrous dysplasia, renal osteodystrophy, malformation osteitis, bone metastases, and multiple myeloma. Laboratory tests mainly showed that blood calcium was mostly increased, blood phosphorus was mostly lower than normal, serum alkaline phosphatase was often increased, and urinary calcium and phosphorus excretion could be increased.
(8) Multiple myeloma and metastatic bone tumor
Multiple bone pains can also be caused by multiple myeloma or bone metastases. Myeloma is a malignant tumor of plasma cells characterized by infinite proliferation of abnormal plasma cells (myeloma cells) and infiltration of bone and soft tissues. Because myeloma cells infinitely proliferate in the bone marrow cavity, invade bones, affect the supply of cortical blood flow, cause diffuse osteoporosis and localized bone destruction, so many bone pain is the earliest and main symptoms of this disease. The beginning may be mild, short-lived and limited, and as the disease progresses, it gradually worsens and becomes widespread and painful. The most common site is the lumbar spine, followed by the pelvis and limbs. Bone destruction can cause pathological fractures. X-ray findings: Osteoporosis is a characteristic of this disease. The trabecular bone becomes thinner and the cortex becomes thinner, accompanied by a reduced density of miliary small pieces. Localized round, oval or irregular bone destruction zone. When the bone destruction tends to be serious, the damaged areas are closely adjacent to each other, and the shape thereof may be a honeycomb shape, a soap bubble shape, a rat bite shape, or an eggshell shape. The diagnosis mainly relies on laboratory tests; the plasma globulin is increased, the ratio of albumin to globulin is inverted, and the protein in the urine is positive. Myeloma cells can be seen by bone marrow examination. Any malignant tumor has the possibility of bone metastasis in theory, but in fact it is not. Some tumors rarely metastasize to the bone, so it is called an epithelial tumor, which occurs in the prostate. Bone metastases often occur in kidneys, thick thyroid glands, and lung cancers, which are called osteogenic tumors. Multiple bone pains are early symptoms of bone metastases. When X-ray shows that multiple bone destruction is not difficult to diagnose, ECT is the best way to diagnose early bone metastases. Bone scan imaging is often performed on X-ray for weeks or months, and can be done whole body. scanning.
Osteolytic metastases release a large amount of calcium and phosphorus, which exceeds the normal renal discharge limit, so it can show a slight increase in blood calcium and phosphorus; osteogenic metastases @prostate cancer also release calcium and phosphorus, but It is used again in the process of new bone formation, so serum calcium and phosphorus can be normal or slightly lower. However, alkaline phosphatase was significantly elevated. However, it should be noted that alkaline phosphatase may also increase in metastatic tumors with fractures or liver metastases. Osteolytic metastases have few bone repairs, so most of them are in the normal range. Acid phosphatase can only increase when prostate cancer invades surrounding soft tissues or metastasizes to bones.
