【摘要】 目的和方法 从临床角度分析了115例肾小管性酸中毒(RTA)的病因、发病率及有关化验、治疗方法。结果和结论 (1)原发性RTA占23.5%，继发性RTA占76.5%，误诊率为33%，要引起临床高度重视。(2)免疫性疾病伴发RTA明显增多，占27.8%。(3)临床分型：I型最常见为71%，II型14%，III型7%，IV型为8%。(4)尿酸化试验是诊断RTA首选的筛选试验，治疗后数年仍阳性。40/115例是通过检查该化验发现RTA的。其它如微量蛋白、Tamm-Horsfall糖蛋白(T-HP)均能反映小管间质损害。抗肾集合管抗体(+)提示免疫性疾病。(5)枸橼酸合剂、钙及维生素D制剂治疗要循序渐进，可以减少不必要的副作用。

    Clinical analysis of 115 cases of renal tubularacidosis Jiang Yongdi,Chen Nan,WangZhaohui,et al.Department of Nephrology, Rui-jin Hospital,Shanghai Second MedicalUniversity,Shanghai,200025

    【Abstract】 Objective and Methods 115 patients with renal tubular acidosis (RTA) were studied withrespect to etiology, morbidity, laboratory examination and therapy. Results andconclusion (1)The prevalences of primaryand secondary RTA were 23.5% and 76.5% respectively. 33% of mistaken diagnosis rate shouldbepaidgreatattentionto.(2)RTApatientsassociatedwithimmunologicaldiseaseincreased(27.8%). (3)Clinical types: Type I (71%) was most common as compared with type II (14%)and type III (7%). On the other hand, type IV was not rare (8%). (4)Urine acidificationtest should be the first choice to diagnose RTA. The test was still positive after severalyears of treatment. Other tests, such as Tamm-Horsfall protein and trace proteinuria,could also reflect tubulostitial impairment. Positive anticollecting tubular antibody canindicate immunological disease. (5)Albright Mixture、 calcuimand Vit D should be used step by step to minimize the unnecessary side-effect.

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