摘要
为研究慢性肾功能衰竭（肾衰）患者铝中毒的原因，诊断和治疗，测定了２７例正常人，２８例不同类型的肾脏病肾功能正常者，６５例慢性肾衰血液透析患者，１６例慢性肾衰非透析患者的血铝和４１例骨铝浓度。１７例患者作了祛铁胺（ＤＦＯ）试验，其中１０例作了ＤＦＯ治疗。结果显示，尿毒症透析患者铝中毒的主要原因是铝制剂的应用与透析用水处理不当。铝中毒可以引起贫血、脑病和骨病，但临床表现无特异性。铝中毒的诊断需作多次血铝的测定或ＤＦＯ试验。ＤＦＯ能螯合各种组织中的铝，而后释放入血循环，其能反映骨组织中铝的实际负荷，静脉输入ＤＦＯ后血铝浓度的改变与骨铝水平呈正相关，提示ＤＦＯ试验有助于铝中毒的诊断。ＤＦＯ治疗的指征：（１）尿毒症患者应用了水处理不当的透析用水治疗或摄入了含铝制剂；（２）血铝浓度高于２００μｇ／Ｌ和ＤＦＯ试验阳性；（３）骨铝浓度大于正常人的１０倍以上。本组中用ＤＦＯ２０～４０ｍｇ／ｋｇ缓慢静脉点滴，无严重副作用。
Tostudythecauses,diagnosisandtreatmentofaluminumtoxicityinpatientswithchronicrenalfailure,theserumaluminumconcentrationwasdeterminedin27normalsubjects,28pa-tientsofvariouskindsofdiseaseswithnormalrenalfunctionand81patientsofchronicrenalfailurewithhemodialysisin65andwithoutin16,ofwhom41patientsweredeterminedthealuminumconcen-trationinthebonetissue.Clinicalsymptomswerecarefulyobservedinalpatientsanddesferioxamine(DFO)testwasperformedin17patients,ofwhom10weretreatedwithDFO.Theresultsshowedthattreatmentwithimproperlyprocessedwaterandadministrationofaluminumcompoundwerethemajorcausesofaluminumtoxicityinuremicpatients.Aluminumtoxicitymayinduceanemia,encephalopathyandbonedisease,butitsclinicalfeatureswerenonspecificandthediagnosismayrequireseveralserumaluminumdeterminationsorDFOtest.DFOcanchelatealuminuminavarietyoftissuessothatthelat-termaybereleasedintothebloodcirculation.TheDFOtestmaybeusedtoassesstheactualaluminumloadinthebonetissue.ThechangesinserumaluminumconcentrationafterintravenousinfusionofDFOcorrelatedcloselywithbonealuminumlevel,suggestingthattheDFOtestmaybeusefulforthediagnosisofaluminumtoxicity.TheDFOtherapymaybeindicatedfor:1.patientswithuremiahavinghyperaluminumnemiaduetotreatmentwithimproperlyprocessedwaterandintakeofaluminum-con-tainingagents.2.thosewhohadserumaluminumconcentrationofhigherthan200μg/LandpositiveDFOtestand3.patientswhosealuminumconcentrationinthebonetissuewas10timesgreaterthannormalvalues.Inthisstudy,DFOwasgivenintravenouslyinadoseof20～40mg/kg,twiceaweek.Satisfactoryresultswereobtainedin3to6monthsandtherewerenoseveresideefectswhentheagentwasadministeredslowly.
出处
《中华内科杂志》
CAS
CSCD
北大核心
1996年第1期36-40,共5页
Chinese Journal of Internal Medicine
