Martínez-Piñeiro L, Mateos F, Martínez M E, Martínez I, Martínez-Piñeiro J A
Department of Urology, La Paz Hospital, Madrid, Spain.
Br J Urol. 1993 Dec;72(6):858-67. doi: 10.1111/j.1464-410x.1993.tb16287.x.
Investigations in animals have shown that nicotinic acid, an intestinal cyclic-AMP inhibitor, partially corrects the metabolic changes associated with urinary diversion through intestinal segments. Blood and serum chemistry were studied in patients before and 3 to 5 months after undergoing urinary diversion through ileal segments, both with and without nicotinic acid treatment. It was found that diverted patients had metabolic acidosis, an increased anion gap and increased levels of serum alkaline phosphatase; there were no significant changes in serum PTH and vitamin D levels, calcaemia and phosphoraemia. There was a tendency towards dehydration, hypernatraemia, hyperchloraemia and secondary hyperaldosteronism produced by ileal secretion of a hypotonic fluid. Nicotinic acid 3 g/day significantly reduced the chloraemia but did not correct the metabolic acidosis, although it reduced its severity, since blood pH decreased when treatment was suspended. Nicotinic acid cannot be recommended for routine use in the management of metabolic acidosis after urinary diversion, and patients with a marginal renal reserve should not be considered for trans-intestinal urinary diversion.
对动物的研究表明，烟酸作为一种肠道环磷酸腺苷抑制剂，可部分纠正因通过肠段进行尿流改道而引起的代谢变化。对接受回肠段尿流改道的患者在术前以及术后3至5个月进行了血液和血清化学研究，部分患者接受了烟酸治疗，部分未接受。结果发现，接受尿流改道的患者出现代谢性酸中毒、阴离子间隙增加以及血清碱性磷酸酶水平升高；血清甲状旁腺激素和维生素D水平、血钙和血磷水平无显著变化。存在因回肠分泌低渗液导致脱水、高钠血症、高氯血症和继发性醛固酮增多症的倾向。每天3克烟酸可显著降低血氯水平，但虽能减轻代谢性酸中毒的严重程度却无法纠正该症状，因为停药后血液pH值会下降。不建议将烟酸常规用于尿流改道后代谢性酸中毒的治疗，且不应考虑为肾储备功能临界的患者进行经肠尿流改道。
