柠檬酸盐抗凝剂对不同种族和性别人电解质代谢的影响

The influence of citrate anticoagulant on the electrolyte metabolism in healthy volunteers with different genders and races

的探讨柠檬酸盐抗凝剂对不同性别和不同种族人电解质代谢的影响，为临床检测干预提供参考。方法应用自身交叉、安慰剂对照研究模式，对22名年龄匹配的中国人（男女各11名）和10名白人男性志愿者以标准化的干预方案分别给予柠檬酸盐抗凝剂[1．5mg／（kg·min）]和相同体积生理盐水（安慰剂）的输注（洗脱间隔期为2～3周）；同时采集干预过程中的系列血样和尿样进行血、尿相关指标的检测。结果22名中国男女试验对象问的基础清蛋白[男（43．05±1．81）g/L，女（42．26±2．67）g/L]和游离钙离子浓度[男（1．27±0．04）mmol／L，女（1．26±0．04）mmol／L]相近；柠檬酸盐的输入可导致中国女性较中国男性有更大的离子钙浓度降幅[女-28．68％（-20．00％～-35．2％），男-23．84％（-16．53％～-29．32％），t=3．19，P〈0．01]，但其对血磷[男-18．81％（-3．16％～-25．09％），女-19．23％（-1．22％～-32．16％）]及清蛋白[男-0．32％（3．27％～-7．60％），女1．88％（6．03％～-9．31％）]的代谢影响性别间差异无统计学意义（t值分别为0．36，0．47，P均〉0．05）；柠檬酸盐干预可同时导致中国人尿钙排泄增加[干预前0．34（0．09～0．87），干预后0．96（0．18～1．47），t=6．66，P〈0．01]。与白人男性相比，中国男性具有较高的离子钙基础水平[中国男性（1．27±0．04）mmol／L，白人男性（1．22±0．02）mmol／L，t=3．7，P〈0．01]和较大幅度的清蛋白生理节律性波动[中国男性-11．72％（-5．70％～-14．21％），白人男性-1．74％（2．43％～-7．68％），t=7．43，P〈0．01]。但两种族男性在柠檬酸盐致血离子钙[中国男性-23．84％（-16．53％～-29．32％），白人男性-21．95％（-18．31％-30．92％）]、磷[中国男性-19．23％（4．65％～-32．16％），白人男性-12．68％（0．68％～-42．19％）]、清蛋白[中国男性一0．32％（1．05％～-7．60％），白人男性-1．39％（1．87％～-7．26％）]和尿钙排泄[中国男性237．70％（11．8％-93.5％），白人男性234．37％（5．45％～504．00％）]的代谢变化差异无统计学意义（t值分别为0．32、0．03、0．25和0．04，P均〉0．05）。2种干预模式下试验对象的镁离子浓度均未见变化。结论柠檬酸盐抗凝剂对机体镁、磷离子及清蛋白的代谢影响不存在着种族和性别间的差异。但其对钙离子代谢影响的性别差异性预示着在机采过程中女性比男性有更高的低钙血症副反应发生的可能。

Objective To investigate the possible effect of citrate on electrolyte metabolism in healthy people with different genders and races and provide a reference for the possible clinical interventions. Methods A cross over, placebo-controlled study was conducted in 22 age-matched Chinese （11 males and 11 females） and 10 male Caucasian volunteers after informed consents were obtained. Volunteers received two standardized interventions containing either citrate at the dose of 1.5 mg/（kg ·min） or the same volume of saline solution, separated by a wash-out period of two to three weeks. Serial blood and urine samples were collected during the observation period and analyzed for the selective biochemical parameters. Results Comparable basal levels of serum albumin [ male （ 43.05 ± 1.81 ） g/L vs female （42.26 ± 2. 67 ） g/L ] and serum ionized calcium [ male （ 1.27 ± 0. 04） mmol/L vs female （ 1.26 ±0. 04） mmol/L] were observed between different genders of Chinese volunteers. However, citrate intervention led to more pronounced decrease of ionized calcium level in Chinese females compared to Chinese males [ -28. 68% （ -20. 00% - -35.2% ） vs - 23. 84% （ - 16. 53% - - 29. 32% ）, t = 3.19, P 〈 0. 01 ]. There was no differences of the levels of serum inorganic phosphate [ - 18. 81% （ -3.16% - -25. 09% ） vs - 19. 23% （ - 1.22% - -32. 16% ）, t=0.36, P 〉 0. 05 ] and albumin [ -0.32%（3.27% - -7.60%） vs 1.88%（6.03% - -9.31%）, t= 0. 47, P 〉0. 051. Independent of gender, citrate intervention resulted in an increased excretion of urine calcium in Chinese volunteers [ before 0. 34 （ 0. 09 - 0. 87 ） vs after 0. 96 （0. 18 - 1.47 ） , t = 6. 66, P 〈 0. 01 ]. Compared to Caucasian males, Chinese males has a higher basal level of serum ionized calcium [ （ 1.27 ±0. 04 ） mmot/L vs （ 1.22 ± 0. 02 ） mmol/L, t = 3.7, P 〈 0.01 ] and larger amplitude basal rhythm in serum albumin level [ -11.72%（ -5.70% - -14.21%） vs -1.74%（2.43% - -7.68%）, t= 7.43, P 〈 0.01 ] . Application of citrate resulted in comparable changes of serum ionized calcium [-23.84%（ - 16.53% - - 29.32%） vs -21.95% （ - 18.31% - - 30.92%）], phosphate [ -19.23%（4.65% - -32.16%） vs -12.68%（0.68% - -42. 19%）], albumin [ -0.32%（1.05% - -7.60%） vs - 1.39% （1.87% - -7.26%）] and urine calcium excretion [237.70% （11.8% - 935% ） vs 234. 37% （5. 45% -504. 00% ） J between Chinese and Caucasian males （t =0. 32, 0. 03, 0. 25 and 0. 04 respectively, P 〉 0. 05 ）. Serum levels of magnesium were not influenced in all volunteers during two interventions. Conclusions Independent of race and gender, the invention of citrate results in comparable changes of serum magnesium, inorganic phosphate and albumin. The effect of citrate on ionized calcium levels between genders implicates a higher risk for hypocalcemic reactions in females compared to males undergoing automatic apheresis procedures.