Williams J J, Rodman J S, Peterson C M
N Engl J Med. 1984 Sep 20;311(12):760-4. doi: 10.1056/NEJM198409203111203.
We studied the effects of the bacterial urease inhibitor acetohydroxamic acid on the growth of struvite stones in the urinary tract. Eighteen patients who received acetohydroxamic acid (15 mg per kilogram of body weight per day, in divided oral doses) for a mean of 15.8 months were compared in a randomized double-blind study with 19 patients who received placebo for a mean of 19.6 months. Seven patients given placebo reached a pre-determined end point: a 100 per cent increase in the two-dimensional surface area of their stones. No patient who received acetohydroxamic acid had a doubling of stone size (P less than 0.01). Nine patients receiving the drug and one patient receiving placebo required a decrease in dosage or cessation of treatment because of adverse effects (P less than 0.01). Episodes of tremulousness (n = 5, P less than 0.05), which reversed with a decrease in drug dose, and phlebothrombosis (n = 3, P not significant) were limited to the group given acetohydroxamic acid. We conclude that acetohydroxamic acid effectively inhibits the growth of struvite stones in the short term in patients infected with urea-splitting bacteria, but the prevalence of adverse reactions appears to be high and the toxicity and effectiveness of long-term therapy for struvite nephrolithiasis remain to be defined.
我们研究了细菌脲酶抑制剂乙酰氧肟酸对尿路中鸟粪石结石生长的影响。在一项随机双盲研究中，将18例平均服用乙酰氧肟酸（每日每千克体重15毫克，分口服剂量）15.8个月的患者与19例平均服用安慰剂19.6个月的患者进行了比较。7例服用安慰剂的患者达到了预定终点：结石二维表面积增加100%。接受乙酰氧肟酸治疗的患者中，没有一例结石大小翻倍（P<0.01）。9例接受该药物治疗的患者和1例接受安慰剂治疗的患者因不良反应需要减少剂量或停止治疗（P<0.01）。震颤发作（n=5，P<0.05）在减少药物剂量后逆转，静脉血栓形成（n=3，P无显著性差异）仅限于服用乙酰氧肟酸的组。我们得出结论，乙酰氧肟酸在短期内可有效抑制感染尿素分解菌患者的鸟粪石结石生长，但不良反应的发生率似乎较高，鸟粪石肾结石长期治疗的毒性和有效性仍有待确定。
