Pak C Y, Peterson R, Sakhaee K, Fuller C, Preminger G, Reisch J
Am J Med. 1985 Sep;79(3):284-8. doi: 10.1016/0002-9343(85)90305-5.
Thirteen patients with hypercalciuric calcium nephrolithiasis continued to form calcium stones when treated with thiazide (4.69 +/- 6.62 [mean +/- SD] stones per patient-year to 5.12 +/- 10.87 stones per patient-year), despite adequate hypocalciuric response (a reduction in urinary calcium levels from 303 +/- 119 mg per day to 193 +/- 88 mg per day, p less than 0.01). Because they had hypocitraturia (250 +/- 86 mg per day versus 643 +/- 236 mg per day in normal subjects, p less than 0.001), potassium citrate (10 to 20 meq three times per day) was added to the ongoing treatment program. During combined treatment with thiazide and potassium citrate, urinary pH significantly rose, and normal levels of urinary citrate were restored. Ten patients stopped forming new stones and all 13 had reduced stone formation rate. Thus, potassium citrate supplementation should be considered in patients requiring thiazide therapy for the control of hypercalciuric nephrolithiasis, especially if they have concurrent hypocitraturia or if it develops during thiazide therapy.
13例高钙尿性钙肾结石患者在接受噻嗪类药物治疗时仍持续形成钙结石（每位患者每年形成结石4.69±6.62[均值±标准差]个至5.12±10.87个），尽管尿钙排泄减少已达到足够水平（尿钙水平从每日303±119毫克降至193±88毫克，p<0.01）。由于他们存在低枸橼酸尿症（每日250±86毫克，而正常受试者为643±236毫克，p<0.001），遂在持续治疗方案中加用枸橼酸钾（每日3次，每次10至20毫当量）。在噻嗪类药物与枸橼酸钾联合治疗期间，尿pH值显著升高，尿枸橼酸水平恢复正常。10例患者停止形成新结石，所有13例患者的结石形成率均降低。因此，对于需要使用噻嗪类药物治疗以控制高钙尿性肾结石的患者，尤其是那些同时存在低枸橼酸尿症或在噻嗪类药物治疗期间出现低枸橼酸尿症的患者，应考虑补充枸橼酸钾。
