肾小管性酸中毒骨骼并发症的临床分析

Clinical analysis of bone complications in renal tubular acidosis

目的总结肾小管酸中毒（RenalTubularAcidosis，RTA）骨骼并发症的特征，探讨原发性肾小管酸中毒（PrimaryRTA，PRTA）与干燥综合征继发肾小管酸中毒（RTASecondarytoSjogren‘ssyndrome．SRTA）骨病表现的差异和特点。方法回顾性分析本院1996年～2010年收治的原发性及干燥综合征继发性肾小管酸中毒。收集患者基本信息、临床表现，实验室检查以及同位素骨密度检查结果。比较两组患者骨病发生率以及骨骼病变的异同。结果研究纳入PRTA共144例（男性63例、女性81例），SRTA共109例（男性10例、女性99例）。PRTA患者平均年龄37．93岁，SRTA患者平均年龄42．44岁。原发组骨痛及关节痛22例（15．3％），骨量减少3例（2．1％），骨质疏松17例（11．8％），骨病变35例（24．3％）。继发组骨痛及关节痛25例（22．9％），骨量减少lO例（9．2％），骨质疏松9例（8．3％），骨病变患者41例（37．6％）。SRTA组骨病发生率明显高于PRTA组（P〈0．05）。9例PRTA患者与11例SRTA患者同位素骨密度检查发现PRTA患者腰椎T大于SRTA患者（一0．53±0．97VS一1．65±1．29，P〈0．05），提示干燥组骨质疏松较原发组更为明显。结论干燥综合征是SRTA最常见的原因，干燥综合征继发RTA患者骨病的发生率及严重程度均高于PRTA患者。

Objectives This study aims to investigate the features of bone complications secondary to renal tubular acidosis（RTA） and to further discuss the differences and characteristics of clinical manifestations between patients with primary RTA （PRTA） or RTA Secondary to Sj？ gren＇s syndrome （SRTA） patients.Methods We retrospectively recruited 109 SRTA patients and 144 PRTA patients who admitted to our clinical center during 1996 and 2010.Baseline demographic,clinical features,laboratory examinations,outcomes and isotope bone density examination were collected and analyzed.Results The study included 144 PRTA and 109 SRTA patients.In PRTA group,there were 63 men and 81 women,the average age was 38 years; In SRTA group,there were 10 men and 99 women,the average age was 42 years..Within the PRTA group,bone pain and joint pain occured in 22 cases （15.3%）,reduced bone mass was observed in 3 cases （2.1%）,osteoporosis was found in 17 cases （11.8%）.While in SRTA group,25 patients （22.9%） were reported to have bone pain and joint pain,and reduced bone mass was found in 10 cases （9.2%）,9 cases （8.3%） of the patients had osteoporosis.Accordingly,more patients with bone disease were detected in SRTA group than in PRTA group （37.6% vs 24.3%,p 〈 0.05）.The isotope bone density with lumbar spine T value of 9 PRTA patients is more than the SRTA patients.Additionally,SRTA patients had a lower lumber spine T value than PRTA patients （-0.53 ± 0.97 vs-1.65 ± 1.29,P 〈 0.05） by isotope bone density test which indicated a higher frequency and more severe bone disease occurred in RTA patients with Sj？ gren ＇s syndrome than primary RTA patients.Conclusions Sjgren＇s syndrome is the most common cause of secondary RTA,the incidence and severity of bone disease was higher in RTA patients secondary to Sj？ gren＇s syndrome than primary RTA patients,which aroused early diagnosis and clinical attentions.