肾小管酸中毒195例临床诊疗分析  

Clinical analysis of 195 patients with renal tubular acidosis

作　　者：邵怡[1] 曲玉清[1] 王先令[1] 王安平[1] 吕朝晖[1] 窦京涛[1] 巴建明[1] 杜锦[1] 谷伟军[1] 郭清华[1] 杨国庆[1] 杨丽娟[1] 陆菊明[1] 母义明[1] SHAO Yi QU Yuqing WANG Xianling WANG Anping LYU Zhaohui DOU Jingtao BA Jianming DU Jin GU Weijun GUO Qinghua YANG Guoqing YANG Lijuan LU Jurning MU Yiming(Department of Endocrinology, Chinese PLA General Hospital, Beijing 100853, China)

机构地区：[1]解放军总医院内分泌科,北京100853

出　　处：《解放军医学院学报》2016年第9期923-927,共5页Academic Journal of Chinese PLA Medical School

基　　金：国家自然科学基金项目(81471026)~~

摘　　要：目的通过对大样本肾小管酸中毒（renal tubular acidosis,RTA）病例分析,总结该疾病的病因、临床特点及有效治疗方法。方法分析本院1993-2015年收治的195例RTA患者临床资料,对RTA的病因进行归类,并分析预后。结果本组男51例,女性144例,年龄2～79岁。原发性RTA占23.1%,继发性RTA占76.9%。病因涵盖干燥综合征（42.6%）、慢性肾疾病（12.8%）、肾毒性药物（4.1%）等。首发症状有乏力、萎靡（69.7%）,烦渴、多饮、多尿（45.6%）,肢瘫（39.5%）,骨关节痛（33.8%）等。在常规纠酸、电解质紊乱基础上,对于原发病为活动期干燥综合征（83例）、系统性红斑狼疮（2例）、类风湿关节炎（2例）应用糖皮质激素（口服）或联合应用环磷酰胺静滴治疗,获得病情长期缓解。结论对RTA患者进行明确的病因及表型甄别并给予相应的对症治疗,特别是对于活动期自身免疫性疾病患者应用免疫抑制,能够改善长期预后。Objective To analyze the etiology, clinical features, causes and treatment of renal tubular acidosis（RTA） through analyzing clinical data about patients with RTA. Methods One hundred and ninety-five cases with RTA hospitalized in Chinese PLA General Hospital from 1993 to 2015 were retrospectively analyzed. All the clinical and laboratory data were collected. The etiology of RTA was identified, and its prognosis was summarized. Results In this cohort, there were 51 male and 144 female cases with age ranging from 2 to 79 years. Primary RTA and secondary RTA accounted for 23.1% and 76.9%, respectively. The etiology of RTA included Sjgren＇s syndrome（SS）（42.6%）, chronic kidney disease（12.8%）, nephrotoxicity drugs（4.1%） and so on. The most common initial symptoms were feebleness（69.7%）, followed by polydipsia and polyuria（45.6%）, limbs paralysis（39.5%）, arthralgia（33.8%）, etc. Routine treatments on metabolic acidosis and electrolyte disturbances was performed. Immune suppressive therapy with glucocorticoid or/and cytoxan on patients with active SS（n=83）, systemic lupus erythematosus（n=2） and rheumatoid arthritis（n=2） was effective to achieve disease relief and antibody titers decrease. Conclusion Clinicians should improve the understanding of complex causes and various clinical manifestations of RTA. Early diagnosis and effective treatment, especially immune suppressive therapy on active autoimmune diseases, can improve the patients＇ quality of life and reduce complications.

关 键 词：肾小管酸中毒 代谢性酸中毒 自身免疫疾病 

分 类 号：R692.6[医药卫生—泌尿科学]