Yendt E R, Cohanim M
Kidney Int. 1978 May;13(5):397-409. doi: 10.1038/ki.1978.58.
On the basis of almost 15 years of experience with thiazide treatment in 346 patients with calcium stones, we believe that the following conclusions are justified: 1) Stone progression ceases in at least 90% of patients who take hydrochlorothiazide (50 mg, twice daily) on a regular basis. 2) A reduced dose of hydrochlorothiazide, i.e., 25 mg twice daily, appears to be effective in a significant proportion of patients. 3) Thiazides are effective in normocalciuric as well as hypercalciuric patients and in most patients with tubular ectasia (medullary sponge kidney). 4. Side effects necessitate discontinuation of thiazide treatment in approximately 7% of patients. The incidence and severity of side effects is reduced by initiating treatment with a small dose and by increasing the dose progressively until the full maintenance dose is achieved. A trial with a reduced dose is warranted in patients who are unable to tolerate the regular maintenance dose. 5) The therapeutic efficacy of thiazides in stone prevention cannot be accurately predicted by the degree of hypocalciuric response. Stone prevention may cease despite a minimal hypocalciuric response, whereas stone progression may occur when an adequate hypocalciuric response has taken place. 6) In addition to the hypocalciuric action, thiazides reduce urine oxalate excretion and increase urine zinc and (probably) magnesium; these effects probably contribute to the efficacy of this agent in stone prevention.
基于对346例钙结石患者进行近15年噻嗪类药物治疗的经验，我们认为以下结论是合理的：1）至少90%定期服用氢氯噻嗪（50毫克，每日两次）的患者结石不再进展。2）较低剂量的氢氯噻嗪，即每日两次25毫克，对相当一部分患者似乎有效。3）噻嗪类药物对正常钙尿症患者以及高钙尿症患者和大多数肾小管扩张（髓质海绵肾）患者有效。4. 约7%的患者因副作用需要停用噻嗪类药物治疗。通过小剂量开始治疗并逐渐增加剂量直至达到完全维持剂量，可降低副作用的发生率和严重程度。对于无法耐受常规维持剂量的患者，有必要进行低剂量试验。5）噻嗪类药物在预防结石方面的治疗效果不能通过低钙尿反应程度准确预测。尽管低钙尿反应最小，结石预防仍可能停止，而当出现足够的低钙尿反应时，结石可能进展。6）除了低钙尿作用外，噻嗪类药物还可减少尿草酸排泄并增加尿锌和（可能）镁；这些作用可能有助于该药物在预防结石方面的疗效。
