Kwak Cheol, Kim Hee Kyung, Kim Eui Chong, Choi Myung Sik, Kim Hyeon Hoe
Department of Urology, Seoul National University College of Medicine and Clinical Research Institute, Seoul National University Hospital, 28 Yongon Dong, Jongno Ku, Seoul 110-744, Republic of Korea.
Eur Urol. 2003 Oct;44(4):475-81. doi: 10.1016/s0302-2838(03)00318-x.
We performed a prospective study to evaluate the intestinal colonization of Oxalobacter formigenes and its relationship with urinary oxalate levels in patients with calcium oxalate stone disease.
One hundred and three patients with calcium oxalate urolithiasis, ranging in age from 21 to 73 years (mean age, 47 years) who were followed from August 2000 to September 2001 participated in this study. Fresh stool and 24-hour urine samples were collected. Genus specific oligonucleotide sequences corresponding to the homologous regions residing in the oxc gene were designed. In order to quantify O. formigenes in clinical specimens, a quantitative-PCR-based assay system utilizing a competitive DNA template as an internal standard was developed. Urine volume, pH, creatinine, oxalate, calcium, magnesium, phosphate, citrate and uric acid were measured.
Intestinal Oxalobacteria were detected in 45.6% (n=47) of calcium oxalate stone patients by PCR. In stone formers who tested negative for Oxalobacteria, the average urinary oxalate level was 0.36 mmol/day, and this compared to 0.29 mmol/day for those patients that tested positive for Oxalobacteria (p<0.05). Mean colony forming units per gram of stool of all patients was 1.1 x 10(7) (0-4.1 x 10(8)), and the level of 24 hours urine oxalate significantly decreased with increasing level of colony forming units of O. formigenes (r=-0.356, p=0.021).
Our results support the concept that O. formigenes is important in maintaining oxalate homeostasis and that its absence from the gut may be the risk of calcium oxalate urolithiasis.
我们进行了一项前瞻性研究，以评估产甲酸草酸杆菌在草酸钙结石病患者中的肠道定植情况及其与尿草酸水平的关系。
2000年8月至2001年9月随访的103例草酸钙尿石症患者参与了本研究，年龄在21至73岁之间（平均年龄47岁）。收集新鲜粪便和24小时尿液样本。设计了与oxc基因中同源区域相对应的属特异性寡核苷酸序列。为了定量临床标本中的产甲酸草酸杆菌，开发了一种基于定量PCR的检测系统，该系统使用竞争性DNA模板作为内标。测量尿量、pH值、肌酐、草酸、钙、镁、磷酸盐、柠檬酸盐和尿酸。
通过PCR在45.6%（n = 47）的草酸钙结石患者中检测到肠道草酸杆菌。在草酸杆菌检测为阴性的结石形成者中，平均尿草酸水平为0.36 mmol/天，而草酸杆菌检测为阳性的患者为0.29 mmol/天（p<0.05）。所有患者每克粪便的平均菌落形成单位为1.1 x 10(7)（0 - 4.1 x 10(8)），随着产甲酸草酸杆菌菌落形成单位水平的增加，24小时尿草酸水平显著降低（r = -0.356，p = 0.021）。
我们的结果支持以下观点，即产甲酸草酸杆菌在维持草酸稳态中很重要，其在肠道中的缺失可能是草酸钙尿石症的风险因素。
