Pak C Y
Center on Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center at Dallas 75235-8885, USA.
Miner Electrolyte Metab. 1994;20(6):371-7.
Citrate is an inhibitor of the crystallization of stone-forming calcium salts. Hypocitraturia, frequently encountered in patients with nephrolithiasis, is therefore an important risk factor for stone formation. Potassium citrate provides physiological and physicochemical correction and inhibits new stone formation, not only in hypocitraturic calcium nephrolithiasis but also in uric acid nephrolithiasis. Inhibition of stone recurrence has now been validated by a randomized trial. Ongoing research has disclosed additional causes of hypocitraturia (sodium excess, low intestinal alkali absorption, but not primary citrate malabsorption). Moreover, new insights on potassium citrate action have been shown, notably that some of absorbed citrate escapes oxidation and contributes to the citraturic response, that ingestion with a meal does not sacrifice physiological or physicochemical action, that orange juice mimics but does not completely duplicate its actions, that potassium citrate may have a beneficial bone-sparing effect, that it may reduce stone fragments following ESWL, and that danger of aluminum toxicity is not great in subjects with functioning kidneys. Finally, the research on potassium citrate has led to two promising products, calcium citrate as an optimum calcium supplement and potassium-magnesium citrate which may be superior to potassium citrate in the management of stone disease.
柠檬酸盐是结石形成性钙盐结晶的抑制剂。因此，肾结石患者中常见的低枸橼酸盐尿症是结石形成的重要危险因素。枸橼酸钾不仅能对低枸橼酸盐尿性钙肾结石，而且对尿酸肾结石提供生理和物理化学纠正，并抑制新结石形成。结石复发的抑制作用现已通过一项随机试验得到验证。正在进行的研究揭示了低枸橼酸盐尿症的其他病因（钠摄入过多、肠道碱吸收不足，但不包括原发性枸橼酸盐吸收不良）。此外，已显示出关于枸橼酸钾作用的新见解，特别是一些吸收的枸橼酸盐逃避氧化并有助于枸橼酸盐尿反应，进餐时服用不会牺牲生理或物理化学作用，橙汁可模拟但不能完全复制其作用，枸橼酸钾可能具有有益的保骨作用，它可能减少体外冲击波碎石术后的结石碎片，并且在肾功能正常的受试者中铝中毒的风险不大。最后，对枸橼酸钾的研究产生了两种有前景的产品，枸橼酸钙作为最佳钙补充剂以及枸橼酸钾镁，在结石病管理方面可能优于枸橼酸钾。
