Höbarth K, Hofbauer J, Szabo N
Department of Urology, University of Vienna, Austria.
Urology. 1994 Jul;44(1):20-4; discussion 24-5. doi: 10.1007/978-1-4615-2556-1_272.
The value of repeated analyses of 24-hour urine collections for daily excretion of calcium, uric acid, citrate, phosphorus, and creatinine and for volume and pH performed to detect and classify metabolic disorders in a selected group of calcium stone formers with striking recurrence rates was assessed in a retrospective study.
A total of 441 urinalyses made over a mean period of 80.4 months of samples obtained from 49 patients were reviewed. Fifty-nine percent of patients were initially found to have metabolic disorders (absorptive hypercalciuria types I and II, hyperuricuria, hypocitraturia) and therefore received specific drug therapy (allopurinol, thiazide, alkali citrate, orthophosphate) for a mean of 45.7 months (group I). The remaining patients were classified as metabolically inactive and were given general metaphylactic instructions (group II).
In 73% of patients recurrent stones developed, with no statistically significant difference between the two groups (79% vs 65%). In 55% of group I patients, urinalyses continued to yield abnormal findings during follow-up; however, subsequent abnormal findings were also seen in 40% of the metabolically inactive group II patients. Overall, metabolic disorders were observed at some point in 75% of patients. Only 27% remained recurrence free, and 62% thereof also had pathologic urinary findings.
It does not appear that drug treatment in recurrent calcium urolithiasis based on urinary findings is superior to simple general metaphylactic recommendations, nor that repeated analyses of 24-hour urine collections furnish additional information on the risk of recurrent stone formation or on the presence of risk factors leading to recurrence in the long-term course of disease.
在一项回顾性研究中，评估了对一组复发率极高的特定钙结石形成者进行24小时尿液收集的重复分析，以检测钙、尿酸、柠檬酸盐、磷和肌酐的每日排泄量以及尿液体积和pH值，并对代谢紊乱进行检测和分类的价值。
回顾了从49例患者中获取的样本在平均80.4个月期间进行的总共441次尿液分析。最初发现59%的患者患有代谢紊乱（I型和II型吸收性高钙尿症、高尿酸尿症、低枸橼酸尿症），因此接受了平均45.7个月的特定药物治疗（别嘌醇、噻嗪类、枸橼酸钾、正磷酸盐）（I组）。其余患者被归类为代谢无活性，并给予一般预防性指导（II组）。
73%的患者出现复发性结石，两组之间无统计学显著差异（79%对65%）。I组55%的患者在随访期间尿液分析持续出现异常结果；然而，代谢无活性的II组患者中也有40%出现了后续异常结果。总体而言，75%的患者在某个时间点观察到代谢紊乱。只有27%的患者无复发，其中62%也有病理性尿液检查结果。
基于尿液检查结果对复发性钙尿路结石进行药物治疗似乎并不优于简单的一般预防性建议，对24小时尿液收集进行重复分析也未提供关于复发性结石形成风险或导致疾病长期复发的危险因素存在情况的额外信息。
