Pak Charles Y C, Poindexter John R, Peterson Roy D, Heller Howard J
Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8885, USA.
J Urol. 2004 Mar;171(3):1046-9. doi: 10.1097/01.ju.0000104860.65987.4a.
We determined whether the biochemical and physicochemical backgrounds of patients with brushite stones differ from those with hydroxyapatite and calcium oxalate stones.
From a computer data base of patients completing ambulatory evaluation 19 with brushite stones, 24 with hydroxyapatite stones and 762 with calcium oxalate stones were identified with the specified composition in greater than 70% of stones.
Absorptive hypercalciuria type I was present in 63% of patients with brushite, 17% with hydroxyapatite and 30% with calcium oxalate stones. Distal renal tubular acidosis was noted in 32% of patients with brushite, 42% with hydroxyapatite and 3% with calcium oxalate stones. Mean urinary calcium in the brushite group was significantly higher than in the hydroxyapatite and calcium oxalate groups (265 +/- 125 vs 186 +/- 103 and 187 +/- 95 mg daily, respectively). Urinary pH in the brushite group was slightly but significantly higher than in the calcium oxalate group (6.15 +/- 0.30 vs 5.91 +/- 0.42). The brushite relative saturation ratio in the brushite group was marginally higher than in the hydroxyapatite group and significantly higher than in the calcium oxalate group (3.25 +/- 2.03 vs 2.34 +/- 1.51 and 1.83 +/- 1.66, respectively).
Patients with predominantly brushite stones could be distinguished from those with predominantly hydroxyapatite and calcium oxalate stones by higher urinary saturation with respect to brushite due mainly to hypercalciuria from absorptive hypercalciuria.
我们确定了透钙磷石结石患者的生化和物理化学背景是否与羟基磷灰石结石和草酸钙结石患者不同。
从完成门诊评估的患者计算机数据库中，识别出19例透钙磷石结石患者、24例羟基磷灰石结石患者和762例草酸钙结石患者，其结石中特定成分含量超过70%。
Ⅰ型吸收性高钙尿症在63%的透钙磷石结石患者、17%的羟基磷灰石结石患者和30%的草酸钙结石患者中存在。32%的透钙磷石结石患者、42%的羟基磷灰石结石患者和3%的草酸钙结石患者存在远端肾小管酸中毒。透钙磷石结石组的平均尿钙显著高于羟基磷灰石结石组和草酸钙结石组（分别为每日265±125mg vs 186±103mg和187±95mg）。透钙磷石结石组的尿pH值略高于但显著高于草酸钙结石组（6.15±0.30 vs 5.91±:0.42）。透钙磷石结石组的透钙磷石相对饱和度略高于羟基磷灰石结石组，且显著高于草酸钙结石组（分别为3.25±2.03 vs 2.34±1.51和1.83±1.66）。
主要为透钙磷石结石的患者可通过相对于透钙磷石更高的尿饱和度与主要为羟基磷灰石结石和草酸钙结石的患者区分开来，这主要是由于吸收性高钙尿症导致的高钙尿症。
