266例成人及儿童肾小管酸中毒临床特征分析  

Clinical characteristics of renal tubular acidosis in adults and children

作　　者：申丛榕 于澈 张璐[2] 苏文燕 吕智美[1] 王荣[1] Shen Congrong;Yu Che;Zhang Lu;Su Wenyan;Lyv Zhimei;Wang Rong(Division of Nephrology,Shandong Provincial Hospital Affiliated to Shandong University,Jinan 250021,China)

机构地区：[1]山东大学附属省立医院肾内科,济南250021 [2]山东大学附属省立医院临床医学检验部,济南250021

出　　处：《中华肾脏病杂志》2018年第9期667-672,共6页Chinese Journal of Nephrology

基　　金：国家自然科学基金（81370834）

摘　　要：目的分析和比较成人及儿童肾小管酸中毒（RTA）的临床特征。方法收集山东省立医院1991年1月至2017年9月收治的RTA患者的临床资料，按照患者年龄分为成人组和儿童组。回顾性分析成人及儿童肾小管酸中毒临床表现和特点。结果成人组206例，儿童组60例。成人组RTA以继发性（89．81％）多见，最常见病因为原发性干燥综合征。儿童组RTA以原发性（81．67％）多见，继发病因多为系统性遗传代谢病。成人组及儿童组RTA均以Ⅰ型最为常见，Ⅱ型多见于儿童原发性肾小管疾病。首发／主诉症状常为多饮、多尿（41．4％）和疲乏、肌无力（35．3％）。儿童组以生长发育迟缓、佝偻病和胃肠道症状等表现突出。RTA误诊及漏诊率为41．4％。治疗包括对症、病因治疗及防治并发症。95．5％的患者经治疗后病情好转。结论RTA病因复杂，临床表现多样。成人以继发性多见，儿童以原发性多见。应提高对儿童RTA的重视程度，降低漏误诊率及致畸率。Objective To view and compare the clinical characteristics of renal tubular acidosis in adults and children. Methods Clinical data of patients with renal tubular acidosis diagnosed by Shandong Provincial Hospital affiliated to Shandong University from Jan 1991 to Sep 2017 were reviewed. The difference and consistency in clinical characteristics of renal tubular acidosis between adults and children were analyzed. Results Data from 206 adults and 60 children were analyzed. 89.81% cases in adults were secondary to other diseases, mainly primary Sjogren＇s syndrome. Most children patients （81.67%） were idiopathic, others largely originated from inherited metabolic diseases. The most common subtype of both was distal renal tubular acidosis. Proximal renal tubular acidosis was easier to be found in idiopathic renal tubular diseases of children. Chief complaints or starting symptoms were mainly composed of polydipsia with polyuria （41.4%） and fatigue （35.3%）. Children were typical of growth retardation, rickets and digestive symptoms. The rate of missed diagnosis and misdiagnosis was 41.4 percent. Routine therapy consisted of healing metabolic acidosis and electrolyte disorders, treating underlying diseases and preventing complications. The majority of patients （95.5%） improved after treatments. Conclusions Renal tubular acidosis possesses various underlying diseases, diverse clinical manifestation and high rate of misdiagnosis. Given the high incident of secondary types, investigation of underlying disease, especially autoimmune diseases such as Sjogren＇s syndrome, is of great importance in adults. Most children patients suffer from primary renal tubular acidosis. Attention should be paid to them in order to reduce the rate of misdiagnosis and teratogenicity.

关 键 词：肾小管酸中毒 成人 儿童 干燥综合征 

分 类 号：R726.9[医药卫生—儿科] R692[医药卫生—临床医学]