Schwille P O, Rümenapf G, Wölfel G, Köhler R
Department of Surgery, University of Erlangen, Federal Republic of Germany.
J Urol. 1988 Aug;140(2):239-45. doi: 10.1016/s0022-5347(17)41573-4.
The excretion of inorganic pyrophosphate was studied in daily, fasting and postprandial urine specimens of normocalciuric and hypercalciuric patients with recurrent renal calcium stone disease (40 men and 40 women), and healthy controls (20 men and 20 women). Both populations were subdivided into younger (20 to 40 years old) and older (more than 40 years old) individuals. In general, there was a tendency towards higher urinary pyrophosphate excretion with increasing age (both sexes and all groups studied), and lower excretion in women than in men. The urinary pyrophosphate excretion rate was unchanged in daily and fasting urine specimens of the younger male normocalciuric and idiopathic hypercalciuric stone patients, whereas in the daily and postprandial urine of younger women the median excretion rate was reduced (controls versus normocalciuric plus idiopathic hypercalciuric subjects, 3 versus 1 mumol., p less than 0.05). In contrast, in older men urinary pyrophosphate was reduced in daily specimens (controls versus normocalciuric plus idiopathic hypercalciuric subjects, 55 versus 33 mumol., p less than 0.05) but it was unchanged in fasting urine specimens. In older women no change was detectable in any of the 3 urine portions. Factorization of urinary pyrophosphate for the associated urinary creatinine did not alter these results substantially, and the presence of renal stones did not modify pyrophosphate excretion significantly. Urinary pyrophosphate was correlated significantly with urinary volume, citrate and phosphorus. We conclude that only subclassification of stone patients with respect to sex, age and type of calciuria, and consideration of additional urine portions besides the daily urine may help to uncover states of urinary pyrophosphate deficit. On the basis of the data, we recommend that clinically relevant studies on inhibitory effects of urinary pyrophosphate on the nucleation and growth of crystals and stones should be done preferentially in urine portions with a proved pyrophosphate deficit.
对患有复发性肾钙结石病的正常钙尿症和高钙尿症患者（40名男性和40名女性）以及健康对照者（20名男性和20名女性）的每日、空腹和餐后尿液样本中的无机焦磷酸盐排泄情况进行了研究。这两组人群又被细分为较年轻（20至40岁）和较年长（40岁以上）个体。总体而言，随着年龄增长（所有研究的性别和组），尿焦磷酸盐排泄有增加的趋势，且女性排泄低于男性。年轻男性正常钙尿症和特发性高钙尿症结石患者的每日和空腹尿液样本中尿焦磷酸盐排泄率无变化，而年轻女性的每日和餐后尿液中，中位数排泄率降低（对照组与正常钙尿症加特发性高钙尿症受试者相比，分别为3与1 μmol，p<0.05）。相比之下，年长男性的每日尿液样本中尿焦磷酸盐减少（对照组与正常钙尿症加特发性高钙尿症受试者相比，分别为55与33 μmol，p<0.05），但空腹尿液样本中无变化。年长女性的3份尿液样本中均未检测到变化。将尿焦磷酸盐与相关的尿肌酐进行因子分解，并未实质性改变这些结果，肾结石的存在也未显著改变焦磷酸盐排泄。尿焦磷酸盐与尿量、柠檬酸盐和磷显著相关。我们得出结论，只有根据性别、年龄和钙尿类型对结石患者进行亚分类，并考虑每日尿液之外的其他尿液样本，才可能有助于发现尿焦磷酸盐缺乏状态。基于这些数据，我们建议，关于尿焦磷酸盐对晶体和结石成核及生长抑制作用的临床相关研究，应优先在已证实存在焦磷酸盐缺乏的尿液样本中进行。
