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題名 | 青少年高尿鈣機轉之研究:口服鈣負荷與利尿劑之腎臟反應 |
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作者姓名(中文) | 陳遠浩; | 書刊名 | 中華民國小兒科醫學會雜誌 |
卷期 | 28:4 民76.07-08 |
頁次 | 頁244-255 |
分類號 | 416.27 |
關鍵詞 | 口服; 反應; 利尿劑; 青少年; 研究; 負荷; 高尿鈣; 腎臟; 鈣; 機轉; |
語文 | 中文(Chinese) |
中文摘要 | 為求對我們曾在國人7~8歲,1,072位正常學生之尿液生化中導致結果石的危險因子的分析中所顯示的:16~18歲者比16歲以下者有較高的尿鈣濃度,以及臨床上在20歲以下的結石者中,以16~20歲才佔大部分之原因做進一步的探討,本研究以18歲、12歲及8歲三不同發育年齡層之正常學生在低鈣(<600mg/天)與低鈉(<2gm/天)的欲食限制下,分別給予每位元受試驗者元素鈣,1,000mg/M^2 BSA進行了連續三天的口服鈣負荷試驗(Oral Calcium-Loading Test),並對其所有之24小時尿液中鈣、肌酸酐及鈉等生物化物做的測定分析中發現18歲、12歲及8歲者於口服鈣負荷試驗後,尿液中之鈣與肌酸酐的比值(Uca/Ucr)分別為0.349±0.151,0.146±0.078,0.195±0.055mg/mg,遊離鈣之賢臓排泄百分率(FECa)分別為5.77±2.60,1.92±0.93,2.39±0.71%,尿液中之鈣濃度分別為24.0±5.85,6.54±5.02,5.97±3.25mg/d1, 24小時尿鈣排泄量分別為2.65±0.93,1.51±0.75,1.68±0.53mg/kg/day及遊離鈣之腎臓郭清率(CCa)分別為7.05±3.09,1.90±0.91,2.39±0.74ml/min/1.73^2,而顯示18歲者於口服鈣負荷試驗後之尿鈣排泄比12歲與8歲者之口服鈣負荷試驗後的尿鈣排泄有很明顯的增加(P<0.01)。而以18歲、12歲及8歲三不同年齡層之正常學生也在同一飲食限制下分別接受了連續二天的不同口服利尿劑Acetazolamide 10mg/kg,Furosemide 2mg/kg 及Hydrochlorothiazide 2mg/kg,並對其尿鈣排泄的測定分析中發現;18歲者於服用Furosemide之尿鈣排泄量(1.39±0.50°2.53±0.72^1,1.95±0.23^11,1.71±0.70^11mg/kg/day)僅在服用該藥之第二天(ⅠⅡ)之尿鈣排泄量比在服用該藥前(0)有明顯的增加(P,0.01),而在12歲者之尿鈣排泄量(1.67±0.88^0,2.11±0.48^1,1.70±0.47^11mg/kg/day)與8歲者之尿鈣排泄量(1.97±0.93^0,2.27±0.96^1,1.71^11mg/kg/day)均無增加(P<0.05).18歲者於服用Hydrochlorothia-zide 之尿鈣排泄量(1.58±0.65^0,1.15±0.38^1.0.40±0.18^11mg/kg/day)僅在服用該藥之第二天(Ⅱ)才見有尿鈣排泄量比服用該藥前(0)有明顯的減少(P<0.01),而比12歲者之尿鈣排泄量(1.60±0.60^0,0.79±0.33^1.0.45±0.14^11mg/kg/day)有服用Hydro-chlorothiazide 之第一天(Ⅰ)即有明顯的減少之為慢。因此,我們認為18歲者之腸胃道對鈣的高吸收性、其骨骼對鈣需求量的減少與腎小管對鈣再吸收的減少為導致16~18歲學生之尿液中有濃度之鈣及臨床上有高尿路結石發生的主要因素,其中以骨骼對鈣需求量的減少可能為最重要之因素。 |
英文摘要 | To investigate the mechanisms of the higher urinary calcium concentration and higher incidence of renal stones in the 16 to 18 years age group compared to those of 7 to 15 years, as revealed in our previous study of urinary biochemical risk factors of forming stones in Chinese school children, oral calcium-loading and diuretics tests were performed on three age groups of 18, 12 and 8 years respectively. Oral elemental calcium 1,000 mg/M^2 was given for three consecutive days and acetazolamide (diamox) 10 mg/kg, furosemide (lasix) 2 mg/kg and hydrochlorothiazide (dichlortride) 2 mg/kg, for two consecutive days. Quantitative measurements of calcium, creatinine and sodium were made from urine and blood samples. After oral calcium-loading, the urinary calcium creatinine ratio (Uca/Ucr), the fractional excretion of free calcium, the urinary calcium concentration, the 24-hour urinary calcium excretion and the free calcium clearance increased in all age groups, especially much more prominent for the 18 years age group than in those subjects of 12 and 8 years. Oral furosemide induceds much higher urinary calcium excretion in the age group of 18 years when compared with that in 12 and 8 years. In contrast, hydrochlorothiazide decreased urinary calcium excretion more prominently in the age groups of 12 and 8 years when compared with that in 18 years. These results indicate that high calcium absorption in the G-I tract, low calcium requirements of the skeletal system and low calcium reabsorption by the renal tubules are all responsible for the high urinary calcium concentration in the age group 18 years old, with an emphasis on low calcium need of bone as a main factor. |
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