Kanabrocki E L, Ryan M D, Hermida R C, Ayala D E, McCormick J B, Dawson S, Lojo L, Hoffman H S, Siegel G, Friedman N, Eladasori B, Parachuri R, Nemchausky B A
Nuclear Medicine Service, Edward Hines Jr., VA Hospital, Hines, IL 60141, USA.
Clin Ter. 2008 Jan-Feb;159(1):35-40.
The purpose of this study was to examine the circadian distribution of creatinine and uric acid clearances in subjects with Multiple Sclerosis.
Eleven subjects with MS, 6 women (48+/-7y) and 5 men (58+/-5y) volunteered for this circadian study. Thirteen healthy females (39+/-11y) served as controls. Data of seven healthy male controls (64+/-8 y) were extracted from a similar circadian study conducted previously. Each MS patient, and each male control had blood samples drawn around the clock, at 3h intervals (8/24h), and each collected urines over 3h periods (8/24h). Each female control contributed only one blood sample and one complete 24h urine collection. Blood and urine samples were analyzed for a number of relevant analytes: ELAM, IL-6, NO, insulin, ACTH, aldosterone, cortisol, electrolytes, lymphocytes, monocytes including creatinine and uric acid clearances. Those were standardized to an average body surface area of 1.73 m2.
The relevant analytes demonstrated increased synthesis of insulin, IL-6, ELAM, monocytes, and reduced concentrations of serum NO. The creatinine clearances were significantly lower in MS females than in female controls, 63+/-22 vs.108+/-18 ml/min. They were also lower than those of MS males and male controls, 107.8+/-17, 97.5+/-8.2 ml/min. Uric acid clearances in MS females were also lower 6.9+/-2.4 vs. 10.5+/-4.4 ml/min. The uric acid clearance in MS males was higher than in male controls, 7.0+/-4.5 vs. 4.0+/-1.0 ml/min.
The alterations in selected relevant analytes and the reduced creatinine and uric acid clearances in females but not in males, suggest a renal dysfunction in MS females. These observations may contribute to understanding better the mechanism of renal dysfunction in female patients and perhaps this may be an additional factor contributing to greater frequency of MS in females than in male subjects.
本研究旨在检测多发性硬化症患者肌酐清除率和尿酸清除率的昼夜分布情况。
11名多发性硬化症患者（6名女性，年龄48±7岁；5名男性，年龄58±5岁）自愿参与这项昼夜研究。13名健康女性（年龄39±11岁）作为对照。7名健康男性对照（年龄64±8岁）的数据取自先前进行的一项类似昼夜研究。每名多发性硬化症患者和每名男性对照每隔3小时（24小时内共8次）采集血样，每次收集3小时的尿液（24小时内共8次）。每名女性对照仅提供一份血样和一次完整的24小时尿液收集。对血样和尿样进行多种相关分析物检测：ELAM、IL-6、NO、胰岛素、促肾上腺皮质激素、醛固酮、皮质醇、电解质、淋巴细胞、单核细胞，包括肌酐清除率和尿酸清除率。这些指标均按照平均体表面积1.73平方米进行标准化。
相关分析物显示胰岛素、IL-6、ELAM、单核细胞的合成增加，血清NO浓度降低。多发性硬化症女性的肌酐清除率显著低于女性对照，分别为63±22和108±18毫升/分钟。也低于多发性硬化症男性和男性对照，分别为107.8±17、97.5±8.2毫升/分钟。多发性硬化症女性的尿酸清除率也较低，分别为6.9±2.4和10.5±4.4毫升/分钟。多发性硬化症男性的尿酸清除率高于男性对照，分别为7.0±4.5和4.0±1.0毫升/分钟。
所选相关分析物的改变以及女性而非男性肌酐清除率和尿酸清除率的降低，提示多发性硬化症女性存在肾功能障碍。这些观察结果可能有助于更好地理解女性患者肾功能障碍的机制，这或许也是女性多发性硬化症发病率高于男性的一个额外因素。
