Batlle D C, Downer M, Gutterman C, Kurtzman N A
J Clin Invest. 1985 May;75(5):1517-30. doi: 10.1172/JCI111856.
This study was designed to establish the relationship between urinary pCO2 and systemic blood pCO2 during acute hypercapnia and to investigate the significance of this relationship to collecting duct hydrogen ion (H+) secretion when the urine is acid and when it is highly alkaline. In rats excreting a highly alkaline urine, an acute increase in blood pCO2 (from 42 +/- 0.8 to 87 +/- 0.8 mmHg) resulted in a significant fall in urine minus blood (U-B) pCO2 (from 31 +/- 2.0 to 16 +/- 4.2 mmHg, P less than 0.005), a finding which could be interpreted to indicate inhibition of collecting duct H+ secretion by hypercapnia. The urinary pCO2 of rats with hypercapnia, unlike that of normocapnic controls, was significantly lower than that of blood when the urine was acid (58 +/- 6.3 and 86 +/- 1.7 mmHg, P less than 0.001) and when it was alkalinized in the face of accelerated carbonic acid dehydration by infusion of carbonic anhydrase (78 +/- 2.7 and 87 +/- 1.8 mmHg, P less than 0.02). The finding of a urinary pCO2 lower than systemic blood pCO2 during hypercapnia suggested that the urine pCO2 prevailing before bicarbonate loading should be known and the blood pCO2 kept constant to evaluate collecting duct H+ secretion using the urinary pCO2 technique. In experiments performed under these conditions, sodium bicarbonate infusion resulted in an increment in urinary pCO2 (i.e., a delta pCO2) which was comparable in hypercapnic and normocapnic rats (40 +/- 7.2 and 42 +/- 4.6 mmHg, respectively) that were alkalemic (blood pH 7.53 +/- 0.02 and 7.69 +/- 0.01, respectively). The U-B pCO2, however, was again lower in hypercapnic than in normocapnic rats (15 +/- 4.0 and 39 +/- 2.5 mmHg, respectively, P less than 0.001). In hypercapnic rats in which blood pH during bicarbonate infusion was not allowed to become alkalemic (7.38 +/- 0.01), the delta pCO2 was higher than that of normocapnic rats which were alkalemic (70 +/- 5.6 and 42 +/- 4.6 mmHg, respectively, P less than 0.005) while the U-B pCO2 was about the same (39 +/- 3.7 and 39 +/- 2.5 mmHg). We further examined urine pCO2 generation by measuring the difference between the urine pCO2 of a highly alkaline urine not containing carbonic anhydrase and that of an equally alkaline urine containing this enzyme. Carbonic anhydrase infusion to hypercapnic rats that were not alkalemic resulted in a fall in urine pCO(2) (from 122+/-5.7 to 77+/-2.2 mmHg) which was greater (P <0.02) than that seen in alkalemic normocapnic controls (from 73+/- 1.9 to 43+/-1.3 mmHg) with a comparable urine bicarbonate concentration and urine nonbicarbonate buffer capacity. CO(2) generation, therefore, from collecting dust H(+) secretion and titration of bicarbonate, was higher in hypercapnic rats that in normocapnic controls. We conclude that in rats with actue hypercapnia, the U-B p(CO(2)) achieved during bicarbonate loading greatly underestimates collecting duct H(+) secretion because it is artificially influenced by systemic blood pCO(2). the deltapCO(2) is a better qualitative index of collecting duct H+ secretion that the U-B pCO(2), because it is not artificially influenced by systemic blood pCO(2) and it takes into account the urine PCO(2) prevailing before bicarbonate loading.
本研究旨在确定急性高碳酸血症期间尿PCO2与全身血液PCO2之间的关系,并探讨当尿液呈酸性和高度碱性时这种关系对集合管氢离子(H+)分泌的意义。在排出高度碱性尿液的大鼠中,血液PCO2急性升高(从42±0.8mmHg升至87±0.8mmHg)导致尿与血(U-B)PCO2显著下降(从31±2.0mmHg降至16±4.2mmHg,P<0.005),这一发现可解释为高碳酸血症抑制了集合管H+分泌。高碳酸血症大鼠的尿PCO2,与正常碳酸血症对照组不同,当尿液呈酸性时(58±6.3和86±1.7mmHg,P<0.001)以及在输注碳酸酐酶加速碳酸脱水使尿液碱化时(78±2.7和87±1.8mmHg,P<0.02),均显著低于血液PCO2。高碳酸血症期间尿PCO2低于全身血液PCO2的发现表明,在使用尿PCO2技术评估集合管H+分泌时,应了解碳酸氢盐负荷前的尿PCO2并使血液PCO2保持恒定。在这些条件下进行的实验中,输注碳酸氢钠导致高碳酸血症和正常碳酸血症大鼠(分别为40±7.2和42±4.6mmHg)的尿PCO2增加(即ΔPCO2),这些大鼠均为碱血症(血液pH分别为7.53±0.02和7.69±0.01)。然而,高碳酸血症大鼠的U-B PCO2再次低于正常碳酸血症大鼠(分别为15±4.0和39±2.5mmHg,P<0.001)。在输注碳酸氢钠期间血液pH值未变为碱血症(7.38±0.01)的高碳酸血症大鼠中,ΔPCO2高于碱血症的正常碳酸血症大鼠(分别为70±5.6和42±4.6mmHg,P<0.005),而U-B PCO2大致相同(39±3.7和39±2.5mmHg)。我们通过测量不含碳酸酐酶的高度碱性尿液与含有该酶的同等碱性尿液的尿PCO2之间的差异,进一步研究了尿PCO2的产生。向非碱血症的高碳酸血症大鼠输注碳酸酐酶导致尿PCO2下降(从122±5.7mmHg降至77±2.2mmHg),这一降幅大于(P<0.02)碱血症的正常碳酸血症对照组(从73±1.9mmHg降至43±1.3mmHg),两组尿液碳酸氢盐浓度和尿液非碳酸氢盐缓冲能力相当。因此,高碳酸血症大鼠中集合管H+分泌和碳酸氢盐滴定产生的CO2高于正常碳酸血症对照组。我们得出结论,在急性高碳酸血症大鼠中,碳酸氢盐负荷期间达到的U-B P(CO2)大大低估了集合管H+分泌,因为它受到全身血液PCO2的人为影响。与U-B PCO2相比,ΔPCO2是集合管H+分泌更好的定性指标,因为它不受全身血液PCO2的人为影响,并且考虑了碳酸氢盐负荷前的尿PCO2。