Paré P, Reynolds T B
Arch Intern Med. 1984 May;144(5):941-4. doi: 10.1001/archinte.1984.00350170077015.
The prevalence of impaired renal acidification in alcoholic liver disease and its relationship to clinical and biochemical features were evaluated during a one-year period in a 60-bed liver unit. No cases of overt renal tubular acidosis (RTA) were found; all of 12 patients with low serum bicarbonate values and normal anion gap proved to have chronic respiratory alkalosis. However, there was a 57% prevalence of incomplete distal RTA in 42 patients who were tested with an acid load. Subjects with RTA had higher serum bilirubin levels (5.3 +/- 6.1 v 2.1 +/- 2.7 mg/dL) and lower prothrombin times (45% +/- 22% v 64% +/- 20%). Urinary pH correlated directly with serum bilirubin levels (r = +.38) and inversely with prothrombin times (r = -.46). The frequency of ascites and encephalopathy did not differ notably between the two groups of patients. No pathogenetic relation was observed with avid sodium retention, decreased excretion of nonreabsorbable anions, and elevated urinary excretion of bile acids. Therefore, we conclude that impaired renal acidification in alcoholic liver disease may be a sign of liver cell failure since it is more frequently observed in patients with a greater degree of liver dysfunction.
在一家拥有60张床位的肝病科，对酒精性肝病患者肾酸化功能受损的患病率及其与临床和生化特征的关系进行了为期一年的评估。未发现明显的肾小管酸中毒（RTA）病例；12例血清碳酸氢盐值低且阴离子间隙正常的患者均被证实患有慢性呼吸性碱中毒。然而，在42例接受酸负荷测试的患者中，不完全性远端RTA的患病率为57%。患有RTA的患者血清胆红素水平较高（5.3±6.1对2.1±2.7mg/dL），凝血酶原时间较低（45%±22%对64%±20%）。尿pH值与血清胆红素水平呈正相关（r = +.38），与凝血酶原时间呈负相关（r = -.46）。两组患者腹水和肝性脑病的发生率无明显差异。未观察到与钠潴留、不可重吸收阴离子排泄减少和胆汁酸尿排泄增加之间的致病关系。因此，我们得出结论，酒精性肝病患者肾酸化功能受损可能是肝细胞衰竭的一个迹象，因为在肝功能障碍程度较重的患者中更常观察到这种情况。
