Fernández-Rodríguez A, Arrabal-Martín M, García-Ruiz Maria J, Arrabal-Polo M A, Pichardo-Pichardo S, Zuluaga-Gómez A
Hospital San Juan de la Cruz, Ubeda (Jaén), Departamento de Cirugia.
Actas Urol Esp. 2006 Mar;30(3):305-9. doi: 10.1016/s0210-4806(06)73444-1.
To show the prolonged efficacy of thiazides in the prophylaxis and treatment of recurrences in patients with calcium oxalate and phosphate lithiasis.
A randomised prospective study is conducted, with a three-year follow-up, in 150 patients diagnosed with recurrent calcium lithiasis. The patients are divided into three groups: A) 50 cases subject to observation with no treatment, B) 50 cases treated with 50 mg/day of hydrochlorothiazide, and C) 50 cases treated with 50 mg of hydrochlorothiazide and 20 mlEq of potassium citrate/day. Each group is subject to a renal study with imaging techniques and a urinary metabolic study at baseline, 12, 24 and 36 months.
The patients treated with thiazides (Groups B and C) obtain a significant reduction in lithiasis recurrence compared with the control group (Group A). The most common abnormality found in the metabolic study was hypercalciuria, 52% of cases; 16% present a mixed lithogenic pattern. The number of recurrences and need for new sessions of extracorporeal lithotripsy in patients with hypercalciuria treated with thiazides is significantly smaller than in Group A (p=0.003).
We observe a significant relation between lithogenic pattern and lithiasis recurrence. Thiazides help us to control lithogenic factors and recurrences in patients with calcium lithiasis. This effect is prolonged and significant in patients with hypercalciuria.
展示噻嗪类药物在预防和治疗草酸钙及磷酸盐结石患者复发方面的长期疗效。
对150例诊断为复发性钙结石的患者进行了一项为期三年随访的随机前瞻性研究。患者分为三组：A组50例，接受观察不治疗；B组50例，每天服用50毫克氢氯噻嗪治疗；C组50例，每天服用50毫克氢氯噻嗪和20毫当量柠檬酸钾治疗。每组患者在基线、12个月、24个月和36个月时接受肾脏成像技术研究和尿液代谢研究。
与对照组（A组）相比，接受噻嗪类药物治疗的患者（B组和C组）结石复发率显著降低。代谢研究中最常见的异常是高钙尿症，占病例的52%；16%呈现混合致石模式。接受噻嗪类药物治疗的高钙尿症患者的复发次数和新的体外冲击波碎石治疗需求显著少于A组（p=0.003）。
我们观察到致石模式与结石复发之间存在显著关联。噻嗪类药物有助于我们控制钙结石患者的致石因素和复发。这种效果在高钙尿症患者中是长期且显著的。
