在慢性脏疾病中进行点诊疗测试,以区分各种酸性疾病
Tomasz Gołębiowski1, Sławomir Zmonarski1, Wiktoria Rożek1
1Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland.
正常阴离子间隔代谢酸化 (AGMA) 在晚期慢性病 (CKD) 患者中更常见,特别是那些功能较好的人. 高阴离子间隙代谢酸化症 (HAGMA) 患者需要更早的置换疗法.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 内部医学 内部医学
- 临床化学 临床化学
背景情况:
- 代谢酸性,包括正常离子间隙代谢酸性 (AGMA) 和高离子间隙代谢酸性 (HAGMA),是慢性病 (CKD) 患者的常见并发症.
- 了解这些酸性疾病的患病率和特征对于管理晚期CKD至关重要.
- 临床检测 (POCT) 提供了一种快速的方法来评估这些患者的酸平衡.
研究的目的:
- 用POCT. 确定晚期CKD (G4-G5阶段) 中不同酸性疾病的患病率.
- 研究各种POCT衍生酸参数之间的关系.
- 在CKD患者中比较AGMA和HAGMA的特征.
主要方法:
- 116名患有G4-G5阶段的CKD患者在动脉静脉瘤手术期间接受了POCT的动脉血液采样.
- 评估的关键参数包括pH,过多 (BE),碳酸盐 (HCO3-),化物 (Cl-),离子间隙 (AG),肌素和尿素.
- 患者根据其酸性疾病类型进行分类.
主要成果:
- 79%的患者发生了代谢性酸症 (HCO3- ≤22 mmol/L),其中59%出现了不补偿性酸症 (pH <7.35).
- 在52%的代谢性酸性病患者中观察到AGMA,48%的代谢性酸性病患者观察到HAGMA.
- 离子间隙 (AG) 与肌素和尿素正相关,而化物 (Cl-) 与碳酸盐 (HCO3-) 负相关.
结论:
- AGMA是晚期CKD中占主导地位的酸干扰,通常与补偿性高血症相关,并且在功能较好的患者中见到.
- 与AGMA相比,HAGMA病例需要更早开始替代疗法.
- 阴离子间隙随着CKD的进展而增加.
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