Murayama T, Taguchi H
Department of Urology, Sagamihara National Hospital.
Hinyokika Kiyo. 1987 Nov;33(11):1766-71.
According to the dynamics of the urinary calcium excretion mechanism, we have classified the patients with urolithiasis into 4 groups, namely group I (normocalciuria; urinary calcium excretion of 270 mg/day or less for male patients and 210 mg/day or less for female patients), group II (absorptive hypercalciuria; hypercalciuric with urinary calcium excretion of 200 mg/day or less under the low calcium diet), group III (renal hypercalciuria; hypercalciuric with urinary calcium excretion exceeds 200 mg/day even under a low calcium diet), and group IV (hyperparathyroidism; hypercalciuric patients as in group III with high serum calcium). Of the 97 stone formers, 77 were classified into group I, 9 into group II, 8 into group III and 3 into group IV. Both under the restricted diet and under the ambulatory free diet, urinary calcium excretion of groups II, III and IV was significantly higher than that of the group I patients. It was noteworthy, however, that some of the patients in group I excreted much calcium without restriction of their diet. Although no difference in excretion of oxalate, magnesium and phosphate was observed between the 4 groups, the patients in groups II, and III excreted more uric acid into their urine than group I patients. As for stone recurrence rate, no difference was noted between group I and group II, III or IV. Based on these findings, we conclude that hypercalciuria has no significant role in the stone forming mechanism. However, lowering of urinary calcium and other stone forming constituents is mandatory in preventing stone recurrence until the mechanism of stone formation is elucidated more precisely.
根据尿钙排泄机制的动态变化，我们将尿路结石患者分为4组，即I组（正常钙尿症；男性患者尿钙排泄量为270毫克/天或更低，女性患者为210毫克/天或更低），II组（吸收性高钙尿症；在低钙饮食条件下尿钙排泄量为200毫克/天或更低时出现高钙尿症），III组（肾性高钙尿症；即使在低钙饮食条件下尿钙排泄量仍超过200毫克/天的高钙尿症），以及IV组（甲状旁腺功能亢进症；血清钙水平高且尿钙排泄情况与III组患者相同的高钙尿症患者）。在97例结石形成者中，77例被归入I组，9例归入II组，8例归入III组，3例归入IV组。在限制饮食和自由活动饮食两种情况下，II、III和IV组的尿钙排泄量均显著高于I组患者。然而，值得注意的是，I组中的一些患者在饮食不受限制的情况下尿钙排泄量也很高。虽然4组之间草酸、镁和磷酸盐的排泄没有差异，但II组和III组患者尿中尿酸的排泄量高于I组患者。至于结石复发率，I组与II、III或IV组之间没有差异。基于这些发现，我们得出结论，高钙尿症在结石形成机制中没有显著作用。然而，在更精确地阐明结石形成机制之前，降低尿钙和其他结石形成成分对于预防结石复发是必不可少的。
