Lin J L, Yang Y J, Yang S S, Leu M L
Division of Nephrology, Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan, ROC.
Am J Kidney Dis. 1997 Nov;30(5):653-8. doi: 10.1016/s0272-6386(97)90489-3.
Presently, aluminum utensils are widely used in the world, especially in the developing countries. However, whether aluminum leaching from such utensils contributes to aluminum accumulation or causes any damage in patients with renal disease remains unknown. We designed a prospective study to evaluate this problem. After excluding patients who were not examined at follow-up or who poorly complied during the study period, the opened randomized study consisted of 42 patients with chronic renal insufficiency (creatinine clearance <60 mL/min and >10 mL/min). All patients had not taken any aluminum-containing agents for 3 months, but used aluminum kitchen utensils for more than 1 year. Twelve patients comprised the control group; the other 30 patients comprised the study group. The aluminum kitchen utensils used by the study group patients were replaced with stainless steel utensils for 3 months, but those used by the control group were not. After 3 months, the decrements of serum aluminum (5.5 +/- 4.6 microg/L v 2.1 +/- 3.5 microg/L; P = 0.012) and daily urine aluminum excretion (14.3 +/- 15.2 microg/d v 2.1 +/- 5.6 microg/d; P = 0.005) in the study group patients were greater than those in the control group patients. The increments of transferrin saturation of the study group patients (1.8% +/- 9.5% v -3.7% +/- 9.5%; P = 0.052) were greater than those of the control group patients. In addition, the increments of iron (r = 0.368, P = 0.035) and transferrin saturation (r = 0.345, P = 0.049) positively correlated with the decrements of daily aluminum excretion in all patients. The study group patients with greater decrements of serum aluminum (>5.5 microg/L) had greater serum iron levels (90.2 +/- 27.7 microg/dL v 71.9 +/- 27.8 microg/dL; P = 0.047) and transferrin saturation (30.5% +/- 11.0% v 23.0% +/- 9.5%; P = 0.046) than those with less decrements of serum aluminum (<5.5 microg/L) after the study. Our study demonstrates that aluminum kitchen utensils may be the important aluminum exposure source for patients with chronic renal insufficiency who are not taking aluminum-containing agents, and hints that the long-term exposure of aluminum leaching from aluminum utensils probably affects iron levels in patients with chronic renal insufficiency. Further studies are clearly needed to confirm this observation.
目前，铝制餐具在世界范围内广泛使用，尤其是在发展中国家。然而，这些餐具中铝的溶出是否会导致铝在体内蓄积或对肾病患者造成损害仍不清楚。我们设计了一项前瞻性研究来评估这个问题。在排除随访时未接受检查或在研究期间依从性差的患者后，这项开放性随机研究纳入了42例慢性肾功能不全患者（肌酐清除率<60 mL/min且>10 mL/min）。所有患者在3个月内未服用任何含铝制剂，但使用铝制厨具超过1年。12例患者为对照组；另外30例患者为研究组。研究组患者使用的铝制厨具被更换为不锈钢厨具，为期3个月，而对照组患者的厨具未更换。3个月后，研究组患者血清铝的下降幅度（5.5±4.6 μg/L对2.1±3.5 μg/L；P = 0.012）和每日尿铝排泄量的下降幅度（14.3±15.2 μg/d对2.1±5.6 μg/d；P = 0.005）大于对照组患者。研究组患者转铁蛋白饱和度的升高幅度（1.8%±9.5%对-3.7%±9.5%；P = 0.052）大于对照组患者。此外，所有患者中铁的升高幅度（r = 0.368，P = 0.035）和转铁蛋白饱和度的升高幅度（r = 0.345，P = 0.049）与每日铝排泄量的下降幅度呈正相关。研究后血清铝下降幅度较大（>5.5 μg/L）的研究组患者的血清铁水平（90.2±27.7 μg/dL对71.9±27.8 μg/dL；P = 0.047）和转铁蛋白饱和度（30.5%±11.0%对23.0%±9.5%；P = 0.046）高于血清铝下降幅度较小（<5.5 μg/L）的患者。我们的研究表明，铝制厨具可能是未服用含铝制剂的慢性肾功能不全患者铝暴露的重要来源，并提示长期接触铝制厨具溶出的铝可能会影响慢性肾功能不全患者的铁水平。显然需要进一步的研究来证实这一观察结果。
