Iwasaki S, Ideura T, Yoshimura A, Chimata M, Kawamura M, Sudo M, Koshikawa S
Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama.
Nihon Jinzo Gakkai Shi. 1990 Jun;32(6):723-8.
Aluminum (Al) accumulation in bone is a serious problem in patients on hemodialysis. We studied deferoxamine infusion test (DFO test) in 14 diabetic patients on hemodialysis (HDDM) and 23 hemodialysis patients originated from glomerulo nephritis (HDCGN) to determine whether Al accumulation is different between the two groups or not. There was no difference in hemodialysis duration and total oral intake of Al containing drugs between two groups. Serum C-terminal parathyroid hormone (C-PTH) in HDDM was lower than that in HDCGN group (1.82 +/- 1.30 vs. 3.80 +/- 1.82 ng/ml; P less than 0.01). However serum Al (s-Al) levels were comparable (61.9 +/- 53.0 vs, 45.0 +/- 32.3 micrograms/l). A significant correlation was observed between duration of dialysis period and s-Al in HDDM (r = 0.806, p less than 0.01), but in HDCGN, the relation was not significant. The patients in HDDM whose cumulative aluminum intake was less than 2.0 kg showed the higher serum A1 concentrations before DFO and greater increases in s-Al after DFO test, as compared with those in HDCGN with matched aluminum intake (93.8 +/- 67.6 vs. 35.9 +/- 23.6 micrograms/l; p less than 0.001 and 141.2 +/- 81.8 vs. 70.3 +/- 41.1 micrograms/l; p = 0.035). These results indicate that in uremic diabetic patients with lower intake of Al containing drugs, an early accumulation of Al in the whole body occurs possibly because of the enhanced absorption rate of Al at an intestine and/or the low PTH level.
铝（Al）在骨中的蓄积是血液透析患者面临的一个严重问题。我们对14例糖尿病血液透析患者（HDDM）和23例源自肾小球肾炎的血液透析患者（HDCGN）进行了去铁胺输注试验（DFO试验），以确定两组之间铝的蓄积是否存在差异。两组患者的血液透析时长以及含铝药物的口服总量均无差异。HDDM组的血清C末端甲状旁腺激素（C-PTH）低于HDCGN组（1.82±1.30对3.80±1.82 ng/ml；P<0.01）。然而，血清铝（s-Al）水平相当（61.9±53.0对45.0±32.3μg/l）。在HDDM组中，透析时长与s-Al之间存在显著相关性（r=0.806，P<0.01），但在HDCGN组中，这种关系并不显著。与铝摄入量匹配的HDCGN患者相比，累积铝摄入量小于2.0 kg的HDDM患者在DFO试验前的血清铝浓度更高，DFO试验后s-Al的升高幅度更大（93.8±67.6对35.9±23.6μg/l；P<0.001以及141.2±81.8对70.3±41.1μg/l；P=0.035）。这些结果表明，在摄入含铝药物较少的尿毒症糖尿病患者中，可能由于肠道铝吸收率提高和/或甲状旁腺激素水平较低，导致铝在全身早期蓄积。
