用碳酸氢钾治疗的绝经后妇女矿物质平衡和骨骼代谢得到改善。

Improved mineral balance and skeletal metabolism in postmenopausal women treated with potassium bicarbonate.

作者信息

Sebastian A, Harris S T, Ottaway J H, Todd K M, Morris R C

机构信息

Department of Medicine, Moffitt-Long Hospitals, University of California, San Francisco 94143.

出版信息

N Engl J Med. 1994 Jun 23;330(25):1776-81. doi: 10.1056/NEJM199406233302502.

DOI:10.1056/NEJM199406233302502

PMID:8190153

Abstract

BACKGROUND

In normal subjects, a low level of metabolic acidosis and positive acid balance (the production of more acid than is excreted) are typically present and correlate in degree with the amount of endogenous acid produced by the metabolism of foods in ordinary diets abundant in protein. Over a lifetime, the counteraction of retained endogenous acid by base mobilized from the skeleton may contribute to the decrease in bone mass that occurs normally with aging.

METHODS

To test that possibility, we administered potassium bicarbonate to 18 postmenopausal women who were given a constant diet (652 mg [16 mmol] of calcium and 96 g of protein per 60 kg of body weight). The potassium bicarbonate was given orally for 18 days in doses (60 to 120 mmol per day) that nearly completely neutralized the endogenous acid.

RESULTS

During the administration of potassium bicarbonate, the calcium and phosphorus balance became less negative or more positive--that is, less was excreted in comparison with the amount ingested (mean [+/- SD] change in calcium balance, +56 +/- 76 mg [1.4 +/- 1.9 mmol] per day per 60 kg; P = 0.009; change in phosphorus balance, +47 +/- 64 mg [1.5 +/- 2.1 mmol] per day per 60 kg; P = 0.007) because of reductions in urinary calcium and phosphorus excretion. The changes in calcium and phosphorus balance were positively correlated (P < 0.001). Serum osteocalcin concentrations increased from 5.5 +/- 2.8 to 6.1 +/- 2.8 ng per milliliter (P < 0.001), and urinary hydroxyproline excretion decreased from 28.9 +/- 12.3 to 26.7 +/- 10.8 mg per day (220 +/- 94 to 204 +/- 82 mumol per day; P = 0.05). Net renal acid excretion decreased from 70.9 +/- 10.1 to 12.8 +/- 21.8 mmol per day, indicating nearly complete neutralization of endogenous acid.

CONCLUSIONS

In postmenopausal women, the oral administration of potassium bicarbonate at a dose sufficient to neutralize endogenous acid improves calcium and phosphorus balance, reduces bone resorption, and increases the rate of bone formation.

摘要

背景

在正常受试者中，通常存在低水平的代谢性酸中毒和正酸平衡（产生的酸多于排泄的酸），且其程度与普通高蛋白饮食中食物代谢产生的内源性酸量相关。在一生中，从骨骼动员的碱对潴留的内源性酸的中和作用可能导致随年龄增长而正常发生的骨量减少。

方法

为验证这一可能性，我们对18名绝经后女性给予恒定饮食（每60千克体重含652毫克[16毫摩尔]钙和96克蛋白质），并给予碳酸氢钾。口服碳酸氢钾18天，剂量为每天60至120毫摩尔，几乎完全中和内源性酸。

结果

在给予碳酸氢钾期间，钙和磷平衡变得不那么负或更正向，即与摄入的量相比排泄减少（钙平衡的平均[±标准差]变化为每60千克体重每天+56±76毫克[1.4±1.9毫摩尔]；P = 0.009；磷平衡变化为每60千克体重每天+47±64毫克[1.5±2.1毫摩尔]；P = 0.007），原因是尿钙和磷排泄减少。钙和磷平衡的变化呈正相关（P < 0.001）。血清骨钙素浓度从每毫升5.5±2.8纳克增加到6.1±2.8纳克（P < 0.001），尿羟脯氨酸排泄从每天28.9±12.3毫克减少到26.7±10.8毫克（从每天220±94微摩尔减少到204±82微摩尔；P = 0.05）。净肾酸排泄从每天70.9±10.1毫摩尔减少到12.8±21.8毫摩尔，表明内源性酸几乎完全被中和。