Chronic renal failure-induced changes in serum and urine bile acid profiles
Chronic renal failure-induced changes in serum and urine bile acid profiles
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DOI：
10.1023/a:1020575001944
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发表时间：
2002-11-01
影响因子：
3.1
通讯作者：
Marin, JJG
中科院分区：
文献类型：
--
作者：
Jimenez, F;Monte, MJ;Marin, JJG
虽然肾脏被认为在胆汁酸 (BA) 排泄中发挥次要作用，但据报道慢性肾衰竭 (CRF) 伴随着 BA 平衡的改变。本工作的目的是评估不同阶段的 CRF 患者或肾移植后 BA 血清浓度和肾脏排泄的变化，并阐明这些变化是否可能与瘙痒（该病的常见症状）的发生有关。这项研究针对 125 名患者进行。他们都没有肝胆功能障碍的病史或迹象。他们要么属于对照组 (N = 31)，要么属于以下三个 CRF 组之一：仅维持低蛋白饮食的患者（饮食组，N = 23）；相同，并定期进行血液透析（透析组，N = 42）；以及之前接受过肾移植超过 1 年且不到 2 年的患者（移植组，N = 29）。通过气相色谱-质谱法测定血清和尿液BA浓度。通过样本收集时回答的问卷对瘙痒进行量化。在 CRF 患者中观察到明显的高胆碱血症以及尿液中 BA 输出量的减少，以及血清和尿液中这些化合物的谱的深刻改变。通过血液透析校正血清中总 BA 的水平，但不校正分子种类的比例。相比之下，肾移植将 BA 血清模式逆转至正常，但由于环孢菌素 A 的免疫抑制治疗，该组中总血清 BA 浓度持续升高。瘙痒症在肾功能受损和高胆碱血症患者中更为常见，尽管这种症状的程度与总或个别 BA 的血清浓度大小之间没有发现显着相关性。相比之下，尽管存在高胆碱血症，但一旦通过肾移植恢复肾功能，所有患者都不会出现瘙痒症状。这些结果表明，肾脏在决定血清 BA 池大小和组成方面发挥着重要作用，高胆碱血症可能是决定 CRF 患者瘙痒发生的一个因素，但不是唯一因素。
Although the kidney is believed to play a minor role in bile acid (BA) excretion, chronic renal failure (CRF) has been reported to be accompanied by alterations in the BA balance. The aim of the present work was to evaluate the changes in BA serum concentrations and renal excretion in patients with different stage of CRF or after kidney transplantation and to elucidate whether these might play a role in the development of pruritus, a common symptom in this disease. This study was carried out on 125 patients. None of them had a history or signs of hepatobiliary malfunction. They belonged either to a control group (N = 31) or to one of the three following CRF groups: patients maintained only on a low-protein diet (diet group, N = 23); the same, together with periodic sessions of hemodialysis (dialysis group, N = 42); and patients who had undergone a kidney transplant more than 1 and less than 2 years before (transplanted group, N = 29). Serum and urine BA concentrations were assayed by gas chromatography-mass spectrometry. Pruritus was quantified by means of a questionnaire answered at the time of sample collection. A marked hypercholanemia together with a reduction in BA output into urine and profound alterations in the profiles of these compounds in both serum and urine in patients with CRF were observed. The levels of total BAs in serum, but not the proportions of molecular species, were corrected by hemodialysis. By contrast, kidney transplant reversed BA serum patterns to normality but, due to immunosuppressive therapy with cyclosporin A, total serum BA concentrations were consistently elevated in this group. Pruritus was more frequent in patients with impaired kidney function and hypercholanemia, although no significant correlation between the degree of this symptom and the magnitude of the serum concentrations of total or individual BAs were found. By contrast, in spite of hypercholanemia, once renal function had been restored by kidney transplantation, none of the patients suffered from pruritus. These results suggest that the kidney plays an important role in determining the serum BA pool size and composition and that hypercholanemia may be a contributing factor, but not the only one, determining the development of pruritus in patients with CRF.