Ninness J R, Kimber R W, McDonald J W
Can Med Assoc J. 1974 Oct 5;111(7):661-5.
Patients on a chronic hemodialysis regimen were studied with respect to their erythrocyte adaptation to anemia. Erythrocyte 2,3-diphosphoglycerate (DPG) concentration was suboptimal compared with that of anemic patients who were not uremic. In uremic patients erythrocyte 2,3-DPG correlated poorly with hemoglobin level but more strongly with plasma pH. Differences between observed levels of erythrocyte 2,3-DPG and the values predicted using data from other anemic patients also correlated with pH. Gradual correction of plasma pH with oral sodium bicarbonate resulted in a substantial increase in erythrocyte 2,3-DPG and a decrease in oxygen affinity. Therefore, maintenance of normal pH in uremic subjects may improve tissue oxygenation. On the other hand, the rapid correction of acidosis during dialysis resulted in increased oxygen affinity. This response was due to the direct effect of pH on oxygen affinity in the absence of a significant change in erythrocyte 2,3-DPG or adenosine triphosphate (ATP) during hemodialysis. Erythrocyte ATP but not 2,3-DPG correlated with serum inorganic phosphate in uremic subjects. A 21% reduction of serum phosphate produced by ingestion of aluminum hydroxide gel had no significant effect on these variables.
对接受慢性血液透析治疗方案的患者进行了红细胞对贫血适应性的研究。与非尿毒症贫血患者相比，尿毒症患者红细胞2,3-二磷酸甘油酸（DPG）浓度未达最佳水平。在尿毒症患者中，红细胞2,3-DPG与血红蛋白水平的相关性较差，但与血浆pH值的相关性更强。观察到的红细胞2,3-DPG水平与使用其他贫血患者数据预测的值之间的差异也与pH值相关。口服碳酸氢钠逐渐纠正血浆pH值会导致红细胞2,3-DPG大幅增加，氧亲和力降低。因此，维持尿毒症患者的正常pH值可能会改善组织氧合。另一方面，透析期间酸中毒的快速纠正会导致氧亲和力增加。这种反应是由于在血液透析期间红细胞2,3-DPG或三磷酸腺苷（ATP）没有显著变化的情况下，pH值对氧亲和力的直接影响。在尿毒症患者中，红细胞ATP而非2,3-DPG与血清无机磷相关。摄入氢氧化铝凝胶使血清磷酸盐降低21%对这些变量没有显著影响。
