肾小管酸中毒合并与未合并自身免疫性疾病患者的临床特点分析

Clinical features of renal tubular acidosis patients with and without autoimmune disease

目的探讨肾小管酸中毒（RTA）合并与未合并自身免疫性疾病患者的临床表现及免疫学特点。方法回顾性分析1999--2009年收治的60例合并自身免疫性疾病与40例未合并自身免疫性疾病RTA患者的临床表现、免疫学检查及肾小管功能等资料。结果合并自身免疫性疾病患者共60例，59例为I型RTA，1例为Ⅱ型RTA，合并的自身免疫性疾病主要为干燥综合征，55例（92％）；最常见的临床表现为无力软瘫（50例，83％）、多饮多尿（28例，47％）、关节痛（28例，47％）和骨病变（24例，40％）。与不合并自身免疫性疾病的40例RTA患者相比，骨病变（40％与20％）及关节痛（47％与22％）的发生率增高（均P〈0．叭），甲状旁腺激素水平均显著升高（P〈0．05）；抗核抗体（ANA）、抗SSA抗体、抗SSB抗体阳性率分别为88％（49／56）、84％（47／56）和43％（24／56），均高于未合并自身免疫性疾病者（均P〈0．05）。结论RTA合并的自身免疫性疾病中，干燥综合征最为多见，骨病变及关节痛发生率高于未合并自身免疫性疾病患者；对有相关症状的患者尽早完成相关检查，以利早期诊断和治疗。

Objective To study clinical and immunological features of renal tubular acidosis （RTA） patients complicated with autoimmunity disease. Methods Data of 60 patients of RTA complicated with autoimmune disease and 40 without it during 1999 and 2009 were reviewed, including clinical features, immunological examinations and renal tubular function. Results Among 60 patients of RTA, 59 were type I , one type Ⅱ, and 55 complicated with Sjogen＇s syndrome （92%）, one with systemic lupus erythematosus, nine with autoimmune thyroid disease, and one with rheumatoid arthritis. Flaccid paralysis was manifested in 50 （83%） RTA patients complicated with autoimmune disease, polyuria in 28 （47%）, polydipsia in 28 （47%）, bone disorder in 24 （40%） and arthralgia in 28 （47%） cases, but of those without autoimmune disease, bone disease only in eight （20%） and arthralgia in nine （22%） cases, with statistically significant difference （ P 〈 0. 01 ）. Serum level of parathyroid hormone increased noticeably, with prevalence of positive antinuclear antibody, anti-SSA antibody and anti-SSB antibody of 88 % （49/56）, 84% （47/56） and 43% （24/56）, respectively in RTA patients with autoimmune disease, all significantly higher than those in the patients without it （ P 〈 0. 05 ）. Conclusions Sjogen＇ s syndrome is the most common and prevalence of bone disorder and arthralgia are significantly higher in patients of RTA complicated with autoimmune disease, which should be examined as early as possible for timely diagnosis and treatment.