高钙尿症的酸性磷酸盐疗法与中性磷酸盐疗法的不同效果。

Differing effects of acid versus neutral phosphate therapy of hypercalciuria.

作者信息

Lau K, Wolf C, Nussbaum P, Weiner B, DeOreo P, Slatopolsky E, Agus Z, Goldfarb S

出版信息

Kidney Int. 1979 Dec;16(6):736-42. doi: 10.1038/ki.1979.190.

DOI:10.1038/ki.1979.190

Abstract

Studies were performed on 12 patients with idiopathic hypercalciuria to evaluate the hypothesis that the acid load accompanying potassium acid phosphate would adversely affect renal calcium reabsorption and citrate excretion compared to the neutral form of the phosphate salt. During acute clearance studies, neutral phosphate (NP) led to a fall in FECa (2.2 +/- 0.6% to 0.8 +/- 0.1%, P less than 0.02) and no change in titratable acidity (TA) or net acid excretion (NAE). Acid phosphate (AP) did not reduce FECa acutely, and led to a rise in TA (22 +/- 4 to 62 +/- 6 muEq/min, P less than 0.02) and NAE (46 +/- 6 to 6 89 +/- 7 muEq/min, P less than 0.02). During chronic administration, AP resulted in higher urinary calcium excretion in both absorptive (187 +/- 29 vs. 141 +/- 18 mg/day, P less than 0.02) and renal hypercalciuric patients (233 +/- 24 vs. 173 +/- 190.02 mg/day, P less than 0.02). Also, TA and NAE were higher following AP, whereas citrate excretion was lower (375.4 +/- 64.6 vs. 633.4 +/- 28.8 mg/day, P less than 0.01). These data suggest that the reported ineffectiveness of AP in the therapy of nephrolithiasis may be related to the deleterious effects of the acid load on calcium and citrate metabolism.

摘要

对12例特发性高钙尿症患者进行了研究，以评估以下假设：与磷酸盐的中性形式相比，磷酸二氢钾伴随的酸负荷会对肾钙重吸收和柠檬酸盐排泄产生不利影响。在急性清除率研究中，中性磷酸盐（NP）导致FECa下降（从2.2±0.6%降至0.8±0.1%，P<0.02），可滴定酸度（TA）或净酸排泄（NAE）无变化。酸性磷酸盐（AP）不会急性降低FECa，并导致TA升高（从22±4升至62±6μEq/min，P<0.02）和NAE升高（从46±6升至89±7μEq/min，P<0.02）。在长期给药期间，AP导致吸收性高钙尿症患者（187±29 vs. 141±18mg/天，P<0.02）和肾性高钙尿症患者（233±24 vs. 173±19mg/天，P<0.02）的尿钙排泄量更高。此外，AP给药后TA和NAE更高，而柠檬酸盐排泄更低（375.4±64.6 vs. 633.4±28.8mg/天，P<0.01）。这些数据表明，报道的AP在肾结石治疗中无效可能与酸负荷对钙和柠檬酸盐代谢的有害影响有关。