Lief P D, Mutz B F, Bank N
J Clin Invest. 1980 May;65(5):1095-103. doi: 10.1172/JCI109762.
The effect of various diuretics on H+ secretion was studied in the isolated short-circuited urinary bladder of the turtle. Mucosal (urinary) chlorothiazide stimulated H+ secretion promptly, from 1.33 +/- 0.24 to 3.03 +/- 0.25 mueq/h (P less than 0.001). The effect was rapidly reversible upon washout of the drug, H+ returning to control levels, 1.37 +/- 0.26 mueq/h (P less than 0.001). Similar effects were observed with mucosal hydrochlorothiazide and mucosal ethacrynic acid/cysteine. Stimulation of H+ secretion occurred in the presence or the absence of exogenous CO2, in the presence or absence of mucosal Na+ and during inhibition of Na+ transport by ouabain. There was no stimulation of H+ secretion by uncomplexed ethacrynic acid or by mucosal furosemide. The nondiuretic sulfonamide, sulfasoxizole, and the nonsulfonamide buffer, borate, had no effect on H+ SECRETION. These observations indicate that the stimulatory effect of diuretics on H+ secretion is not related to active sodium transport, transepithelial electrical potential, or the buffering capacity of the drugs. Since the transepithelial pH gradient at which active H+ secretion was abolished was identical for chlorothiazide-treated tissues (2.68 pH U) as for control tissues (2.65 pH U, NS), the data suggest that the protonmotive force of the H+ pump was unaffected by the diuretic. This observation, plus the rapid onset and reversibility of the drugs, is consistent with an effect on the mucosal membrane to increase H+ conductance (K). The findings raise the possibility that direct enhancement of renal H+ secretion may play a role in the metabolic alkalosis induced by some diuretics.
在离体的龟短路膀胱中研究了各种利尿剂对氢离子分泌的影响。黏膜(尿侧)氯噻嗪能迅速刺激氢离子分泌,从1.33±0.24微当量/小时增至3.03±0.25微当量/小时(P<0.001)。药物洗脱后,这种作用迅速逆转,氢离子分泌恢复至对照水平,即1.37±0.26微当量/小时(P<0.001)。黏膜氢氯噻嗪和黏膜依他尼酸/半胱氨酸也观察到类似作用。无论有无外源性二氧化碳、有无黏膜钠离子以及哇巴因抑制钠离子转运期间,均可刺激氢离子分泌。未结合的依他尼酸或黏膜速尿均不能刺激氢离子分泌。非利尿性磺胺类药物磺胺异恶唑和非磺胺类缓冲剂硼酸盐对氢离子分泌无影响。这些观察结果表明,利尿剂对氢离子分泌的刺激作用与主动钠转运、跨上皮电位或药物的缓冲能力无关。由于氯噻嗪处理的组织(2.68pH单位)与对照组织(2.65pH单位,无显著性差异)中主动氢离子分泌被消除时的跨上皮pH梯度相同,数据提示氢离子泵的质子动力不受利尿剂影响。这一观察结果,加上药物作用起效快且可逆,与对黏膜膜增加氢离子电导(K)的作用一致。这些发现增加了一种可能性,即直接增强肾脏氢离子分泌可能在某些利尿剂诱发的代谢性碱中毒中起作用。