Department of Urologic Surgery, University of Minnesota, Minneapolis, MN 55455, USA.
J Am Coll Surg. 2010 Jul;211(1):8-15. doi: 10.1016/j.jamcollsurg.2010.03.007.
Recent studies suggest that patients undergoing Roux-en-Y gastric bypass (RYGB) for morbid obesity are at risk for hyperoxaluria, nephrolithiasis, and oxalate nephropathy. Our objective was to conduct a long-term prospective longitudinal study to establish the incidence, clinical progression, and severity of hyperoxaluria after RYGB.
Patients undergoing RYGB between December 2005 and April 2007 provided 24-hour urine collections for comprehensive stone risk analysis 1 week before and 3 months and 1 and 2 years after surgery. Primary outcomes were changes in 24-hour urinary oxalate excretion and relative supersaturation of calcium oxalate from baseline to 2 years post-RYGB.
The cohort consisted of 21 patients, including 5 (24%) men and 16 (76%) women. Mean preoperative age and body mass index (calculated as kg/m(2)) were 48.2 +/- 10.5 years (range 25 to 64 years) and 50.5 +/- 9.1 (range 39.7 to 66.6), respectively. Urinary oxalate excretion increased significantly after RYGB (33 +/- 9 mg/day versus 63 +/- 29 mg/day; p <or= 0.001). De novo hyperoxaluria developed in 11 (52%) patients. Increasing age at the time of surgery was predictive of de novo hyperoxaluria developing (odds ratio = 1.162; 95% CI, 1.002-1.347; p = 0.046). The percentage of patients with hypocitraturia increased from 10% at baseline to 48% at 2 years. The relative supersaturation of calcium oxalate was unchanged (1.73 +/- 0.67 versus 2.20 +/- 2.07; p = 0.27).
RYGB is associated with a long-term increase in urinary oxalate excretion and decrease in urinary citrate excretion. Although calcium oxalate relative supersaturation increases early in the postoperative period, this returns to baseline with long-term follow-up. These data suggest that patients who have undergone RYGB are at risk for oxalate nephropathy developing.
最近的研究表明，接受 Roux-en-Y 胃旁路术（RYGB）治疗病态肥胖症的患者存在高草酸尿症、肾结石和草酸肾病的风险。我们的目的是进行一项长期前瞻性纵向研究，以确定 RYGB 后高草酸尿症的发生率、临床进展和严重程度。
2005 年 12 月至 2007 年 4 月期间接受 RYGB 的患者在手术前 1 周和手术后 3 个月、1 年和 2 年时提供 24 小时尿液采集进行全面结石风险分析。主要结局指标是 24 小时尿草酸盐排泄量和 RYGB 后 2 年时钙草酸相对过饱和度的变化。
该队列包括 21 名患者，其中 5 名（24%）为男性，16 名（76%）为女性。平均术前年龄和体重指数（以 kg/m2 计算）分别为 48.2±10.5 岁（范围 25 至 64 岁）和 50.5±9.1（范围 39.7 至 66.6）。RYGB 后尿草酸盐排泄量显著增加（33±9mg/天比 63±29mg/天；p<0.001）。11 名（52%）患者出现新发性高草酸尿症。手术时年龄增加与新发性高草酸尿症的发生相关（优势比=1.162；95%CI，1.002-1.347；p=0.046）。低柠檬酸尿症的患者比例从基线时的 10%增加到 2 年时的 48%。钙草酸相对过饱和度无变化（1.73±0.67 比 2.20±2.07；p=0.27）。
RYGB 与长期尿草酸盐排泄增加和尿柠檬酸排泄减少相关。尽管钙草酸相对过饱和度在术后早期增加，但随着长期随访，其恢复到基线水平。这些数据表明，接受 RYGB 的患者存在发生草酸肾病的风险。
