摘要
为提高对肾小管性酸中毒 (RTA)的临床认识 ,减少误诊和漏诊 ,回顾性分析了90例RTA的病因、临床症状、体征和实验室检查。结果发现原发性RTA占65.6% ,继发性RTA占34.4% ,临床初次误诊高达54.4 %。RTA临床表现无特异性 ,生长发育落后最常见 ,占72.2% ,其中6例合并生长激素缺乏(GHD) ,其他表现有纳差、呕吐、下肢疼痛、骨骼畸形等。临床分型中Ⅰ型最常见 ,占82% ,Ⅱ、Ⅲ型各占6.7 % ,Ⅳ型为4.6%。检测尿酸化功能66例 ,其中Ⅰ型达60例 ,52例明显下降 ,8例轻度下降者经NH4Cl负荷试验确诊。提示RTA在儿童期并非罕见 ,临床误诊率高 ,需提高警惕 ;多种疾病可继发RTA ,临床上应全面判断 ;
s To improve the clinical understanding of the patients with renal tubular acidosis(RTA)and decrease the misdiagnosis and loss of diagnosis.The etiology,clinical symptoms and signs as well as laboraˉtory examination were retrospectively analyzed in90cases with RTA.The results showed as follows(1)Primary RTA accounted for65.6%and while secondary RTA accounting for34.4%.The initial misdiagnosis rate in clinic was higher over54.5%.(2)The clinical presentation was nonspecific,but the retardation of growth and development was the most common features in65RTA patients accounting for72.2%.6of them complicated growth hormone deficiency(GHD).Other clinical manifestation including anorexia and vomiting could be found in42cases,and32cases having pain in lower extremity and osteomalacia.(3)Type I was the most common type in clinical classification,accounting for82%while typeⅡand typeⅢaccounting6.7%respectively,and typeⅣbeing4.6%.(4)Urine acidification test was performed in66cases,of them60beˉlonged to the type I.52cases significantly decreased,while8cases only had mildly decreased confirmed with NH 4 Cl burden assay.Showing that(1)it was not rare in childhood period for patient with RTA,and the misdiˉagnosis rate in clinic was much higher.So,vigilance should be raised.(2)As many diseases could have secˉondary RTA,comprehensive judgment should be given in clinic.And(3)Urine acidification test should be the most reliable indicator for the RTA diagnosis.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2003年第10期622-624,共3页
Journal of Clinical Pediatrics
关键词
肾小管性酸中毒
误诊
病因
临床分型
儿童
renal tubular acidosis retardation of growth and development urine acidification test
