Baggio B, Gambaro G, Marchini F, Marzaro G, Williams H E, Borsatti A
Division of Nephrology, University of Padova, Italy.
Lancet. 1991 Aug 17;338(8764):403-5. doi: 10.1016/0140-6736(91)91030-x.
Calcium-oxalate nephrolithiasis is associated with a defect in erythrocyte oxalate self-exchange and an abnormal rate of erythrocyte membrane protein phosphorylation. There is evidence that glycosaminoglycans (GAGs) have a regulatory effect on both of these processes. This study tested the hypothesis that modifications of erythrocyte oxalate self-exchange induced by oral GAGs are paralleled by similar changes in overall oxalate metabolism. 40 patients with idiopathic calcium-oxalate nephrolithiasis were treated for 15 days with 60 mg/day of a mixture of GAGs. By day 15 of treatment there were significant reductions from baseline in erythrocyte oxalate self-exchange (mean [SD] 1.67 [1.18] vs 2.59 [1.63] x 10(2) per min; p less than 0.005) and erythrocyte membrane protein phosphorylation (55.8 [7.3] vs 72.9 [6.8] x 10(-3) cpm/mg protein; p less than 0.005), but also in urinary oxalate excretion (0.24 [0.09] vs 0.31 [0.15] mmol/24 h; p less than 0.005). This finding suggests similar changes in both erythrocytes and other cells more important in oxalate handling. The changes had reversed by 15 days after withdrawal of treatment. Acute intravenous administration of GAGs (60 mg) induced a fall in carbon-14-labelled oxalate renal clearance (143 [13] vs 169 [28] ml/min; p less than 0.005), which strongly suggests the participation of the kidney. However, reduced oxalate absorption from the intestine, and even decreased synthesis of oxalate, cannot be ruled out.
草酸钙肾结石与红细胞草酸自我交换缺陷及红细胞膜蛋白磷酸化异常速率有关。有证据表明糖胺聚糖（GAGs）对这两个过程均有调节作用。本研究检验了以下假设：口服GAGs诱导的红细胞草酸自我交换改变与草酸盐整体代谢的类似变化平行。40例特发性草酸钙肾结石患者接受60mg/天的GAGs混合物治疗15天。治疗第15天时，红细胞草酸自我交换（平均[标准差]1.67[1.18]对2.59[1.63]×10²/分钟；p<0.005）和红细胞膜蛋白磷酸化（55.8[7.3]对72.9[6.8]×10⁻³cpm/mg蛋白；p<0.005）较基线均显著降低，尿草酸排泄也降低（0.24[0.09]对0.31[0.15]mmol/24小时；p<0.005）。这一发现提示红细胞和其他在草酸处理中更重要的细胞均发生了类似变化。停药15天后这些变化逆转。急性静脉注射GAGs（60mg）导致¹⁴C标记的草酸肾清除率下降（143[13]对169[28]ml/分钟；p<0.005），这强烈提示肾脏参与其中。然而，不能排除肠道草酸吸收减少甚至草酸合成减少的可能性。
