Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
Urology. 2013 Mar;81(3):511-6. doi: 10.1016/j.urology.2012.11.045.
To elucidate the effect of a patient-centered combined nutritional and medical therapy approach on stone disease management, guided by 24-hour urinary stone risk.
We retrospectively analyzed the records of patients treated at our multidisciplinary stone clinic from July 2007 to February 2009. Included were adult stone formers who presented with severe urinary abnormalities or whose urinary parameters failed to improve with dietary changes. Urinary risk factors for stone disease were evaluated before and after intervention with 24-hour urine collections. Hypercalciuria was treated with hydrochlorothiazide/indapamide, hypocitraturia with potassium/calcium citrate, and hyperuricosuria with allopurinol. The primary end point was the effect of combined dietary and medical intervention on levels of urinary metabolites. Statistical comparisons of postintervention urine collection values with baseline values were performed using a paired t test. Two-tailed P <.05 was considered statistically significant.
Data for 137 patients with a mean follow-up of 14.39 months were analyzed. Mean age was 47.2 years, and the male-to-female ratio was 1.04. Hypocitraturia was detected in 70 patients (51%), hypercalciuria in 49 (37%) and hyperuricosuria in 18 (13%). A significant improvement was found in 67% of patients with hypocitraturia (urinary citrate levels: 380.28 to 663.96 mg/d; P <.0001), in 82% of patients with hypercalciuria (urinary calcium levels: 337.4 to 183.6 mg/d; P <.0001), and in 72% of patients with hyperuricosuria (urinary citric acid level: 927 to 600 mg/d; P <.0001).
Medical management of stone disease instituted based on individual risk factors impacts subsequent urinary stone risk, supporting its use for stone disease when patients do not respond to lifestyle and dietary changes.
通过 24 小时尿液结石风险评估，阐明以患者为中心的联合营养和医疗治疗方法对结石病管理的影响。
我们对 2007 年 7 月至 2009 年 2 月在我们多学科结石诊所治疗的患者记录进行了回顾性分析。纳入标准为出现严重尿路异常或饮食改变后尿参数未改善的成年结石患者。在进行 24 小时尿液收集后，评估尿路结石危险因素。高钙尿症用氢氯噻嗪/吲达帕胺治疗，低柠檬酸尿症用柠檬酸钾/钙治疗，高尿酸尿症用别嘌呤醇治疗。主要终点是联合饮食和药物干预对尿代谢物水平的影响。使用配对 t 检验比较干预后尿液收集值与基线值。双侧 P<.05 被认为具有统计学意义。
分析了 137 例患者的数据，平均随访 14.39 个月。平均年龄为 47.2 岁，男女比例为 1.04。70 例（51%）患者存在低柠檬酸尿症，49 例（37%）患者存在高钙尿症，18 例（13%）患者存在高尿酸尿症。67%的低柠檬酸尿症患者（尿柠檬酸盐水平：380.28 至 663.96mg/d；P<.0001）、82%的高钙尿症患者（尿钙水平：337.4 至 183.6mg/d；P<.0001）和 72%的高尿酸尿症患者（尿柠檬酸水平：927 至 600mg/d；P<.0001）的情况有显著改善。
基于个体危险因素的结石病医学管理会影响随后的尿路结石风险，因此当患者对生活方式和饮食改变无反应时，支持将其用于结石病的治疗。
