文章摘要
刘 曦,曹 微,李 青,钱 军,张 波,袁杨刚,邢昌赢.糖尿病肾脏病患者尿酸化功能研究[J].南京医科大学学报,2018,(9):1240~`1246
糖尿病肾脏病患者尿酸化功能研究
Urinary acidification function analysis in patients with diabetic kidney disease
  
DOI:10.7655/NYDXBNS20180914
中文关键词: 糖尿病肾脏病  尿酸化功能  蛋白尿  肾小管
英文关键词: diabetic kidney disease  urine acidification function  proteinuria  tubules
基金项目:国家自然科学基金(81670628,81300573)
作者单位
刘 曦 南京医科大学第一附属医院肾内科江苏 南京 210029 
曹 微 南京医科大学第一附属医院肾内科江苏 南京 210029 
李 青 南京医科大学第一附属医院肾内科江苏 南京 210029 
钱 军 南京医科大学第一附属医院肾内科江苏 南京 210029 
张 波 南京医科大学第一附属医院肾内科江苏 南京 210029 
袁杨刚 南京医科大学第一附属医院肾内科江苏 南京 210029 
邢昌赢 南京医科大学第一附属医院肾内科江苏 南京 210029 
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中文摘要:
      目的:探讨糖尿病肾脏病(diabetic kidney disease,DKD)患者尿酸化功能的变化情况。方法:选取2015年1月—2017年3月在南京医科大学第一附属医院经肾活检明确诊断的DKD患者42例。通过分析尿酸化功能比较DKD患者不同类型肾小管损伤患病率,不同病理分期患者肾小管损伤情况,并进一步探讨DKD患者空腹尿液pH值与临床参数的相关性。结果:DKD者常存在小管酸化功能障碍,其中最多见的是远端小管泌铵功能障碍,其次是远端小管泌氢功能障碍,最少见的是近端小管重吸收碳酸氢盐功能障碍。远端小管泌氢功能障碍患病率在不同病理分期间呈现出增高趋势(P=0.007)。DKD患者重吸收碳酸氢盐功能障碍组甲状旁腺激素水平比无障碍组高(P < 0.05);有无远端小管泌氢功能障碍的患者在24 h尿蛋白、血红蛋白水平上存在差异(P < 0.05);有无远端小管泌铵功能障碍的患者在血红蛋白水平存在差异(P < 0.05)。空腹尿液pH值与24 h尿蛋白水平呈正相关,同时与血清白蛋白呈负相关。尤其当尿蛋白≥3.5 g/d时,尿蛋白定量与尿液pH值呈线性相关。结论:DKD患者最常见的小管酸化功能障碍是远端小管的泌铵功能障碍。可滴定酸异常的DKD患者血红蛋白比正常组患者更低、尿蛋白更高。DKD患者空腹尿液pH值的增加可能与24 h尿蛋白增加有关。
英文摘要:
      Objective:To explore the association of urine acidification function in patients with diabetic kidney disease(DKD). Methods:A total of 42 DKD patients diagnosed by renal biopsy presenting to the first affiliated hospital of NMU from January 2015 to March 2017 were recruited. The prevalence of different kinds of renal tubular injury was analyzed by acidification function. In addition,urine acidification function of different stages,the correlation of urine pH levels and clinical parameters were compared. Results:Patients with DKD often had dysfunction in acidification of the tubules,of which the most common was dysfunction of the distal tubules in the secretion of ammonium,followed by dysfunction of the distal tubules in the secretion of hydrogen,and the least common was the reabsorption of bicarbonate dysfunction in the proximal tubules. The prevalence of the distal tubules dysfunction in the secretion of ammonium showed an increasing trend in different pathological stages(P=0.007). Patients with re?absorption of bicarbonate dysfunction in DKD patients had higher parathormone levels(P < 0.05). Differences in 24?hour urinary protein and hemoglobin levels between patients with and without distal tubules of hydrogenation dysfunction were observed(P < 0.05). The levels of hemoglobin were significantly different between patients with or without ammonium secretion dysfunction in the distal tubules(P < 0.05). Fasting urine pH was positively correlated with 24?h urinary protein level and negatively correlated with serum albumin. Especially when the urinary protein was higher than 3.5 g/d,there was a good linear correlation between urinary protein quantification and urine pH. Conclusion:The most common dysfunction of tubular acidification in patients with DKD was ammonium secretion in the distal tubules. Patients with titer acid anemia had lower hemoglobin levels and higher urinary protein levels than patients in the titer acid normal group. The increase of fasting urine pH in DKD patients may be related to 24?h urinary protein.
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