肾小管泌氢功能试验在肾移植监测中的价值

对36例肾移植患者肾移植前与术后8周内的肾小管泌氢功能，包括尿pH、可滴定酸（TA）、NH4＋、酸净排出量（NAC）及HCO3-浓度进行动态监测，以探讨该试验在术后监测中的价值。结果发现，移植前pH及HCO3-明显高于正常，TA、NH4＋及NAC明显低于正常。移植后肾功能稳定恢复组的五个参数均逐渐恢复，其中完全恢复正常者占62．5％；排斥组出现排斥反应时TA、NH4＋及NAC合量下降，随排斥逆转而有所恢复，完全达正常者占37．5％；肾失功组患者TA、NH4＋及NAC始终波动于低水平，而pH与HCO3-增高。结果表明，肾移植术活动态监测肾小管泌氢功能对了解移植肾功能状态、预测排斥反应的发生以及判断疗效和预后具有一定参考价值。

Evaluation on the monitoring of tubular H~ secretion function in renal graft recipients

H secretion functions were examined in 36 patients with chronic renal failure (CRF) before and after renal transplantation. The results showed that the patients had higher urinary pH, HCO3- and lower titrable acid (TA), NH4 and net acid excretion (NAC) levels before operation than those in normal control. These parameters returned to normal levels in patients with well functioning grafts after operation. The TA, NH4 and NAC levels decreased in patients with rejection episodes and could return to normal levels after the reverse of rejection but they were persistently low in patients with irreversible acute rejection with pH and HCO3- staying at high levels. Our results suggested that the monitoring of tubular H secretion function might provide valuable information about renal function status and prognosis.