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[接受常规透析治疗患者的氨基酸肾排泄情况]

[Renal excretion of amino acids in patients on a regular dialysis program].

作者信息

Nádvorníková H, Schück O, Teplan V, Kaslíková J, Tomková D, Reitschlägerová V

机构信息

Institut klinické a experimentální medicíny, Praha.

出版信息

Vnitr Lek. 1994 Apr;40(4):211-4.

PMID:8184580
Abstract

In 10 patients with chronic renal failure and a polyfructosan S clearance (CPFS): 1.91-12.70 ml/min (mean 5.68 ml/min) with a preserved residual diuresis (more than 1000 ml/24 hours) renal excretion of 22 amino acids by residual nephrons was investigated before and 12 hours after haemodialysis. It was revealed that 12 hours after haemodialysis a significant drop of the filtered amount of all investigated amino acids occurred. Renal clearance of Ser, Pro, Glu, Gly, Ala, Tyr, Met, Leu and Cit after haemodialysis declined significantly (p < 0.05-0.001). Haemodialysis was not associated with significant changes of fractionated excretions (FE) of amino acids with the exception of Gly (p < 0.01) and Trp (p < 0.05) where an increase of FE was recorded. Hitherto assembled results are consistent with the idea that a reduction of the tubular resorption of amino acids in the residual nephrons in subjects with chronic renal failure cannot be explained by a change of their filtered amount (as "overflow" aminoaciduria) nor as the consequence of retention of some dialyzable substances which could inhibit tubular transport of amino acids. The reduced tubular transport of some of the investigated amino acids (Cys, Lys, Cit, Met, Asn+Gln, Orn, Ile) was significantly related with the drop of tubular sodium transport.

摘要

在10例慢性肾衰竭且多聚果糖酐S清除率(CPFS)为1.91 - 12.70 ml/分钟(平均5.68 ml/分钟)且残余尿量保留(超过1000 ml/24小时)的患者中,研究了残余肾单位对22种氨基酸的肾排泄情况,分别在血液透析前及透析后12小时进行。结果显示,血液透析后12小时,所有研究的氨基酸滤过量均显著下降。血液透析后,丝氨酸(Ser)、脯氨酸(Pro)、谷氨酸(Glu)、甘氨酸(Gly)、丙氨酸(Ala)、酪氨酸(Tyr)、蛋氨酸(Met)、亮氨酸(Leu)和瓜氨酸(Cit)的肾清除率显著下降(p < 0.05 - 0.001)。除甘氨酸(p < 0.01)和色氨酸(Trp,p < 0.05)排泄分数(FE)增加外,血液透析与氨基酸的分级排泄(FE)显著变化无关。目前汇总的结果与以下观点一致:慢性肾衰竭患者残余肾单位中氨基酸肾小管重吸收减少,既不能用滤过量的变化(如“溢出性”氨基酸尿)来解释,也不是某些可透析物质潴留从而抑制氨基酸肾小管转运的结果。部分研究的氨基酸(半胱氨酸(Cys)、赖氨酸(Lys)、瓜氨酸(Cit)、蛋氨酸(Met)、天冬酰胺 + 谷氨酰胺(Asn + Gln)、鸟氨酸(Orn)、异亮氨酸(Ile))肾小管转运减少与肾小管钠转运下降显著相关。

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