肾小管性酸中毒115例临床分析  

Clinical analysis of 115 cases of renal tubular acidosis

作　　者：江永娣[1] 陈楠[1] 王朝晖[1] 任红[1] 陈晓农[1] 傅秀兰[1] 姚健[1] 董德长[1] 

机构地区：[1]上海第二医科大学附属瑞金医院肾脏科,200025

出　　处：《中华内分泌代谢杂志》1998年第3期155-158,共4页Chinese Journal of Endocrinology and Metabolism

摘　　要：目的和方法　从临床角度分析了１１５ 例肾小管性酸中毒（ Ｒ Ｔ Ａ） 的病因、发病率及有关化验、治疗方法。结果和结论　（１） 原发性 Ｒ Ｔ Ａ 占２３ ．５ ％ ，继发性 Ｒ Ｔ Ａ 占７６ ．５ ％ ，误诊率为３３ ％ ，要引起临床高度重视。（２） 免疫性疾病伴发 Ｒ Ｔ Ａ 明显增多，占２７ ．８ ％ 。（３） 临床分型： Ｉ型最常见为７１ ％ ， Ｉ Ｉ型１４ ％ ， Ｉ Ｉ Ｉ型７ ％ ， Ｉ Ｖ 型为８ ％ 。（４） 尿酸化试验是诊断 Ｒ Ｔ Ａ 首选的筛选试验，治疗后数年仍阳性。４０／１１５ 例是通过检查该化验发现 Ｒ Ｔ Ａ 的。其它如微量蛋白、 Ｔａｍ ｍ Ｈｏｒｓｆａｌｌ 糖蛋白（ Ｔ Ｈ Ｐ）均能反映小管间质损害。抗肾集合管抗体（ ＋ ） 提示免疫性疾病。（５） 枸橼酸合剂、钙及维生素 Ｄ 制剂治疗要循序渐进，可以减少不必要的副作用。Objective and Methods 115 patients with renal tubular acidosis (RTA) were studied with respect to etiology, morbidity, laboratory examination and therapy. Results and conclusion (1)The prevalences of primary and secondary RTA were 23.5% and 76.5% respectively. 33% of mistaken diagnosis rate shouldbepaidgreatattentionto.(2)RTApatientsassociatedwithimmunologicaldiseaseincreased (27.8%). (3)Clinical types: Type I (71%) was most common as compared with type II (14%) and type III (7%). On the other hand, type IV was not rare (8%). (4)Urine acidification test should be the first choice to diagnose RTA. The test was still positive after several years of treatment. Other tests, such as Tamm Horsfall protein and trace proteinuria, could also reflect tubulostitial impairment. Positive anticollecting tubular antibody can indicate immunological disease. (5)Albright Mixture、 calcuim and Vit D should be used step by step to minimize the unnecessary side effect.

关 键 词：肾小管性酸中毒 酸中毒 尿酸化试验 病因 治疗 

分 类 号：R589.6[医药卫生—内分泌] R692.606[医药卫生—内科学]