Robertson W G, Hughes H
King Faisal Specialist Hospital and Research Centre, Department of Biological and Medical Research, Riyadh, Kingdom of Saudi Arabia.
Scanning Microsc. 1993 Mar;7(1):391-401; discussion 401-2.
The hypothesis that mild hyperoxaluria is more important than hypercalciuria in the pathogenesis of urolithiasis is re-examined in the light of new evidence. Small increments in urinary oxalate in the normal to high-normal range are much more critical than similar rises in urinary calcium for increasing the relative supersaturation of urine with respect to calcium oxalate, the oxalate/calcium ratio in urine, the total volume of calcium oxalate crystals excreted, the proportion of abnormally large crystals and aggregates of calcium oxalate and the severity of the disorder as defined by the recurrence rate of stone-formation. Data from the Arabian Peninsula, where the prevalence of calcium-containing stones is considerably higher than in the West, have shown that this occurs in spite of the almost complete absence of hypercalciuria. On the other hand, there is a strong association between stone-formation and the occurrence of mild hyperoxaluria. The life-time expectancy of stone-formation in men from various countries is strongly correlated with the average daily excretion of oxalate in the urine of the normal men in these countries. This relationship extends to include patients with enteric and hereditary hyperoxaluria. There is no such relationship, however, between the life-time expectancy of stones and urinary calcium excretion in the same populations. Studies on the regulation of urinary oxalate indicate that it is largely controlled by the quantity of "free" dietary oxalate available for absorption in the lower intestine. This can be calculated from the intakes of calcium and oxalate and the urinary excretion of calcium.
根据新证据，对轻度高草酸尿症在尿石症发病机制中比高钙尿症更重要这一假说进行了重新审视。在正常至高正常范围内，尿草酸的小幅增加对于提高尿液相对于草酸钙的相对过饱和度、尿中草酸/钙比值、草酸钙晶体排泄的总体积、异常大的草酸钙晶体和聚集体的比例以及由结石形成复发率定义的疾病严重程度而言，比尿钙的类似升高更为关键。来自阿拉伯半岛的数据表明，尽管几乎完全不存在高钙尿症，但那里含钙结石的患病率仍大大高于西方。另一方面，结石形成与轻度高草酸尿症的发生之间存在很强的关联。不同国家男性结石形成的预期寿命与这些国家正常男性尿液中草酸的平均日排泄量密切相关。这种关系还包括患有肠道和遗传性高草酸尿症的患者。然而，在相同人群中，结石的预期寿命与尿钙排泄之间不存在这种关系。对尿草酸调节的研究表明，它在很大程度上受可在小肠下部吸收的“游离”膳食草酸量的控制。这可以根据钙和草酸的摄入量以及尿钙排泄量来计算。
