Egan J D, Wells I C
Clin Chem. 1979 Mar;25(3):379-83.
Diminished ability to utilize acetate (acetate intolerance) developed in a male patient on chronic hemodialysis after five years of maintenance dialysis. His ability to utilize lactate was also subnormal. We studied acetate metabolism in vitro by isolating lymphocytes from the patient's blood before dialysis and measuring their ability to convert [1-14C]acetate to 14CO2. His cells metabolized acetate only 35% as well as did lymphocytes from normal adults. The inhibition appeared when the patient's lymphocytes were cultured, and the ability of normal lymphocytes to oxidize acetate decreased after they had been incubated in the patient's plasma. We conclude that an inhibitor of acetate utilization is present in the plasma and in (or on) the cells of this acetate-intolerant patient. The diminished ability of the patient to utilize lactate and the presence of normal concentrations of pyruvate, citrate, and ketone bodies in his blood suggest that the inhibitor functions at the cell surface to impede the entrance of acetate into the cells. The inhibitor appears to be dialyzable; its nature is unknown. Its accumulation in the plasma of chronic hemodialysis patients has not been thus far associated with any deleterious effects other than prolonging the metabolic acidosis of such patients.
一名接受维持性透析五年的慢性血液透析男性患者出现了利用乙酸盐能力下降（乙酸盐不耐受）的情况。他利用乳酸盐的能力也低于正常水平。我们通过在透析前从患者血液中分离淋巴细胞并测量其将[1-¹⁴C]乙酸盐转化为¹⁴CO₂的能力，对体外乙酸盐代谢进行了研究。他的细胞代谢乙酸盐的能力仅为正常成年人淋巴细胞的35%。当培养患者的淋巴细胞时出现了这种抑制作用，并且正常淋巴细胞在患者血浆中孵育后氧化乙酸盐的能力下降。我们得出结论，在这位乙酸盐不耐受患者的血浆以及细胞内（或细胞表面）存在一种乙酸盐利用抑制剂。患者利用乳酸盐能力下降以及其血液中丙酮酸、柠檬酸盐和酮体浓度正常，这表明该抑制剂在细胞表面起作用，阻碍乙酸盐进入细胞。该抑制剂似乎是可透析的；其性质尚不清楚。到目前为止，它在慢性血液透析患者血浆中的积累除了延长此类患者的代谢性酸中毒外，尚未与任何有害影响相关联。
