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目的研究尿钠排泄在渗透压调节中的意义,探讨滤过钠排泄分数对高血糖高渗综合征的预测价值。方法糖尿病患者血糖控制平稳后行馒头餐试验时留取空腹及餐后2 h静脉血与随机中段尿,测定血糖、血钠、血钾、血肌酐、血尿素氮、尿钠、尿肌酐。按照空腹渗透压将研究对象分为研究组(10例)和对照组(22例),比较其年龄、体重指数、尿白蛋白排泄率、HbA1c、餐后2 h渗透压、空腹及餐后2 h血糖、血钠浓度、滤过钠排泄分数等。结果进餐后2 h两组血渗透压分别为:(290.22±4.54)mmol·L-1(对照组)(,302.47±5.02)mmol·L-1(观察组);血钠浓度分别为:(133.45±2.09)mmol·L-1(对照组)(,137.10±1.52)mmol·L-1(观察组);滤过钠排泄分数分别为:(0.89±0.36)(对照组)(,0.56±0.38)(观察组),统计学分析,差异均有显著性(P<0.05)。结论血糖升高导致血浆渗透压升高时,代偿性尿钠排泄增加降低血钠浓度是血渗透压维持正常的机制之一,测定滤过钠排泄分数可以反映机体对渗透压调节能力,预测高血糖高渗综合征(HHS)的发生。
Objective To study the significance of urinary sodium excretion in the regulation of osmotic pressure and to explore the predictive value of filtration sodium excretion fraction in hypertensive hyperosmolar syndrome. Methods After the control of blood glucose in diabetic patients, the fasting and postprandial 2-h venous blood and randomized middle-stage urine samples were collected for determination of blood sugar, serum sodium, serum potassium, serum creatinine, blood urea nitrogen, urine sodium and urine creatinine. The subjects were divided into the study group (n = 10) and the control group (n = 22) according to the fasting blood pressure. The differences of age, body mass index, urinary albumin excretion rate, HbA1c, 2 h postprandial pressure, fasting and postprandial 2 h blood glucose, serum sodium concentration, filtration sodium excretion fraction. Results The blood pressure at 2 h after meal was (290.22 ± 4.54) mmol·L -1 (control group) (302.47 ± 5.02 mmol·L -1) (observation group). The serum sodium concentrations were 133.45 ± 2.09) mmol·L -1 (control group) (137.10 ± 1.52 mmol·L -1) (observation group). The fraction of sodium excreted by filtration were (0.89 ± 0.36) (control group) (0.56 ± 0.38) (observation group), statistical analysis, the difference was significant (P <0.05). Conclusions When hyperglycemia leads to increase of plasma osmotic pressure, the increase of compensatory urinary sodium excretion and the decrease of serum sodium concentration are one of the mechanisms of osmolality maintaining normal. The determination of sodium excretion fraction can reflect the regulation of osmotic pressure, Hyperglycemia Hyperosmolar Syndrome (HHS).