Kocvara R, Plasgura P, Petrík A, Louzenský G, Bartonícková K, Dvorácek J
Department of Urology, General University Hospital, 1st Medical School Prague, Czech Republic.
BJU Int. 1999 Sep;84(4):393-8. doi: 10.1046/j.1464-410x.1999.00216.x.
To assess, in a multicentre prospective randomized study, the effectiveness of specific nonmedical prophylaxis and nonspecific dietary prophylaxis in patients treated after experiencing their first idiopathic calcium-containing kidney stone.
From 1991 to 1994, 242 patients with idiopathic calcium urinary stones from three urological centres were randomly assigned into two groups. In group 1 (intervention, 113 patients), a specific dietary regimen was recommended and thereafter corrected according to a comprehensive metabolic evaluation. Group 2 (control, 94 patients) underwent only minimal metabolic screening and used general dietary measures, with no regular follow-up. An increased fluid intake was recommended in both groups. After 3 years, the effectiveness of the prophylactic and dietary regimens was evaluated in 207 patients.
At entry, the clinical characteristics were comparable in the two groups, with only extracorporeal lithotripsy being more frequent in group 2. Almost 80% of patients reported a high intake of meat and a low intake of dairy products. In group 1 and 2, a recurrent stone was encountered in seven (6%) and 18 (19%) patients, respectively; recurrent and growing stones were found in eight (8%) and 22 (23%) patients, respectively (P<0. 01). There was a higher incidence of bilateral residual (or untreated) stones, and Weddellite stones (P<0.001) among patients with a recurrent or growing stone. An analysis of the dynamics of the metabolic variables indicated the significance of repeated dietary counselling.
Specific dietary therapy, adjusted according to a metabolic evaluation, is more effective than nonspecific general dietary recommendations in preventing the formation of a second urinary stone.
在一项多中心前瞻性随机研究中，评估特异性非药物预防和非特异性饮食预防对首次发生特发性含钙肾结石患者治疗后的有效性。
1991年至1994年，来自三个泌尿外科中心的242例特发性钙尿结石患者被随机分为两组。第1组（干预组，113例患者），推荐了特定饮食方案，随后根据全面代谢评估进行调整。第2组（对照组，94例患者）仅进行了最低限度的代谢筛查，并采用一般饮食措施，无定期随访。两组均建议增加液体摄入量。3年后，对207例患者的预防和饮食方案的有效性进行了评估。
入组时，两组的临床特征具有可比性，仅第2组体外冲击波碎石术更为频繁。近80%的患者报告肉类摄入量高，乳制品摄入量低。第1组和第2组分别有7例（6%）和18例（19%）患者出现复发性结石；分别有8例（8%）和22例（23%）患者发现复发性结石和结石增大（P<0.01）。复发性或增大性结石患者中双侧残余（或未治疗）结石和草酸钙结石的发生率更高（P<0.001）。代谢变量动态分析表明重复饮食咨询具有重要意义。
根据代谢评估调整的特异性饮食疗法在预防第二次尿路结石形成方面比非特异性一般饮食建议更有效。
