Koster J, Erhardt A, Stoeppler M, Mohl C, Ritz E
Department of Internal Medicine, University of Heidelberg, FRG.
Eur J Clin Invest. 1989 Apr;19(2):228-33. doi: 10.1111/j.1365-2362.1989.tb00222.x.
Blood lead (Pb) and urinary Pb before and after i.v. infusion of 1 g of Na2Ca EDTA were determined (atomic absorption) in 46 control subjects and 91 patients with various stages of renal failure (median serum creatinine 2.5 mg dl-1). Under baseline conditions, patients with renal failure had higher blood Pb levels (112 ng ml-1, range 44-272 vs. 76; 36-187 in controls; P less than 0.001) and lower urinary Pb (16.2 nmol 24 h-1 1.73 m-2, 4.86-66.8 vs. 33; 11-91 in controls; P = 0.001). The increment in urinary Pb after EDTA infusion (mobilizable Pb) was higher (795 nmol 4 days-1 1.73 m-2, range 155-5611 vs. 307; 131-1587 in controls; P = 0.001). In 12 patients with renal failure (13%) mobilizable Pb was above the highest value in controls. Mobilizable urinary Pb correlated (r = 0.68) significantly (P = 0.001) with blood Pb, but only marginally with serum creatinine (r = 0.32; P less than 0.007). Mobilizable Pb was higher in patients with renal failure and a history of smoking or occupational Pb exposure and tended to be higher in patients with alcoholism. Ten of 91 patients had gout; increased mobilizable Pb was present in three of the 10. The data confirm relatively high prevalence of elevated body Pb burden in European patients with chronic renal failure. The question is unresolved whether Pb plays a role in the progression of renal failure.
在46名对照受试者和91名处于不同肾衰竭阶段（血清肌酐中位数为2.5mg/dl）的患者中，通过原子吸收法测定了静脉输注1g乙二胺四乙酸二钠（Na2Ca EDTA）前后的血铅（Pb）和尿铅。在基线条件下，肾衰竭患者的血铅水平较高（112ng/ml，范围44 - 272，而对照组为76；36 - 187；P<0.001），尿铅水平较低（16.2nmol/24h/1.73m²，4.86 - 66.8，而对照组为33；11 - 91；P = 0.001）。EDTA输注后尿铅的增加量（可动员铅）更高（795nmol/4天/1.73m²，范围155 - 5611，而对照组为307；131 - 1587；P = 0.001）。在12名肾衰竭患者（13%）中，可动员铅高于对照组的最高值。可动员尿铅与血铅显著相关（r = 0.68；P = 0.001），但与血清肌酐仅呈微弱相关（r = 0.32；P<0.007）。肾衰竭且有吸烟史或职业性铅暴露史的患者可动员铅更高，酗酒患者的可动员铅也往往更高。91名患者中有10名患有痛风；10名中有3名可动员铅增加。数据证实欧洲慢性肾衰竭患者体内铅负荷升高的患病率相对较高。铅是否在肾衰竭进展中起作用这一问题尚未解决。
