Park Sangtae, Pearle Margaret S
Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas, USA.
ScientificWorldJournal. 2005 Nov 11;5:902-914. doi: 10.1100/tsw.2005.118. eCollection 2005.
Metabolic abnormalities are identified in over 90% of stone formers and the institution of preventative dietary and medical measures has resulted in substantial reduction in stone recurrence rates. We review the contemporary approach to metabolic evaluation of urolithiasis. A careful medical and dietary history, stone analysis, serologic tests, and urinalysis constitute the initial screening regimen in patients who have been diagnosed with stones. Risk stratification of patients, based on the outcome of the initial screening tests, determines the need for and extent of urinary evaluation in individual stone formers. Conservative dietary measures or a simple metabolic evaluation and treatment has been described for first-time or low-risk stone formers, although the number of 24-h urine collections needed is debatable. A more extensive metabolic evaluation is recommended for recurrent or high-risk stone formers or for those in whom empiric treatment or medical therapy based on simplified evaluation is unsuccessful. Regardless of etiology, all stone formers should be counseled on dietary measures for stone prevention. The need for medication is determined by the results of 24-h urine analysis and the risk level of the patient. Cost effectiveness of the metabolic evaluation and treatment is strongly influenced by recurrence rate and efficacy of therapy. Metabolic evaluation and treatment has clearly been shown in randomized trials to reduce stone recurrence rates. Further study will determine the extent of evaluation necessary and the need for selective vs. empiric medical therapy for first-time and recurrent stone formers.
超过90%的结石患者存在代谢异常，而采取预防性饮食和医学措施已使结石复发率大幅降低。我们回顾了当前对尿石症进行代谢评估的方法。详细的病史和饮食史、结石分析、血清学检查及尿液分析构成了已确诊结石患者的初始筛查方案。根据初始筛查结果对患者进行风险分层，可确定个体结石患者尿液评估的必要性和范围。对于首次发病或低风险结石患者，已有人描述了保守的饮食措施或简单的代谢评估与治疗方法，不过所需的24小时尿液收集次数仍存在争议。对于复发或高风险结石患者，或基于简化评估的经验性治疗或药物治疗未成功的患者，建议进行更全面的代谢评估。无论病因如何，都应向所有结石患者提供预防结石的饮食措施建议。是否需要用药由24小时尿液分析结果和患者的风险水平决定。代谢评估与治疗的成本效益受复发率和治疗效果的强烈影响。随机试验已明确表明，代谢评估与治疗可降低结石复发率。进一步的研究将确定所需评估的程度，以及首次发病和复发结石患者进行选择性治疗与经验性药物治疗的必要性。
