Bakir A A, Hryhorczuk D O, Ahmed S, Hessl S M, Levy P S, Spengler R, Dunea G
University of Illinois, Dialysis Unit, Cook County Hospital, Chicago 60612.
Clin Nephrol. 1989 Jan;31(1):40-4.
Following the occurrence of aluminum encephalopathy in four patients with chronic renal failure, we studied 34 azotemic patients seen during the same year and five volunteers who took varying combinations of aluminum hydroxide and an alkalinizing citrate (Shohl's) solution. We found that the four encephalopathic cases were older than the 34 azotemic patients (68 years +/- 14 SD, vs 50 +/- 13, p less than 0.05), had a higher mean serum aluminum value (727 micrograms/l +/- 320 vs 92 +/- 73, p less than 0.005), had taken more aluminum hydroxide (5 g/day +/- 0.9 vs 1.6 +/- 1.8, p less than 0.01), and more Shohl's solution (64 ml/day +/- 19 vs 20 +/- 29, p less than 0.01). In all 38 patients the serum aluminum values correlated directly with age (p = 0.01), aluminum hydroxide (p = 0.001) and concomitant citrate intake (p = 0.004). In the five healthy volunteers the 24-hour urinary aluminum excretion increased from a baseline of 22 micrograms +/- 19 SD to 167 +/- 109 (p = 0.05) during aluminum hydroxide intake, rising to 580 +/- 267 (p = 0.01) during the simultaneous intake of citrate and aluminum hydroxide. Corresponding serum aluminum values were 11 micrograms/l +/- 2 SD, 44 +/- 34 (p = 0.1), and 98 +/- 58 (p less than 0.05). Thus citrate seems to enhance aluminum absorption and may cause encephalopathy in patients with chronic renal failure, especially the elderly.
在4例慢性肾功能衰竭患者发生铝性脑病后，我们对同年就诊的34例氮质血症患者以及5名服用不同组合的氢氧化铝和碱化枸橼酸盐（肖尔氏溶液）的志愿者进行了研究。我们发现，4例脑病患者比34例氮质血症患者年龄更大（68岁±14标准差，对比50±13，p<0.05），平均血清铝值更高（727微克/升±320对比92±73，p<0.005），服用的氢氧化铝更多（5克/天±0.9对比1.6±1.8，p<0.01），以及服用的肖尔氏溶液更多（64毫升/天±19对比20±29，p<0.01）。在所有38例患者中，血清铝值与年龄（p = 0.01）、氢氧化铝（p = 0.001）以及同时摄入的枸橼酸盐（p = 0.004）直接相关。在5名健康志愿者中，24小时尿铝排泄量在摄入氢氧化铝期间从基线的22微克±19标准差增加到167±109（p = 0.05），在同时摄入枸橼酸盐和氢氧化铝期间升至580±267（p = 0.01）。相应的血清铝值分别为11微克/升±2标准差、44±34（p = 0.1）以及98±58（p<0.05）。因此，枸橼酸盐似乎会增强铝的吸收，并可能导致慢性肾功能衰竭患者尤其是老年人发生脑病。
