Ashby R, Györy A Z
Department of Chemistry, University of Technology, Sydney, Australia.
Exp Nephrol. 1997 May-Jun;5(3):246-52.
It is proposed that urine is better modelled as a true equilibrium rather than in a supersaturated/metastable state and that the free citrate3- ion plays a major role in maintaining dispersion of the solid particles (reduced agglomeration). Published urinary chemistries, in conjunction with the computer programme SEQUIL, have been used to formulate a novel risk index for calcium stone formation independent of the traditional clinical classification of the stone former. Applying the risk index to three consecutive 24-hour urine samples of 39 untreated Ca stone formers showed that 35 (90%) patients produced at least one abnormal urine. Traditional single urinary parameter assessment, Ca/Cr, oxalate/Cr or citrate/Cr ratios, showed that only 17, 14, and 18% of the patients, respectively, had an abnormality, while taking all three together 24 (70%) had some abnormality and thus 30% were 'idiopathic' stone formers. Treatment regimens have been devised using the computer programme to return an abnormal urine to the normal according to the proposed risk index. In most urines two or more factors had to be changed simultaneously. Clinically there has been only one recurrence in 36 months, whereas before they had 4.4/3 years.
有人提出，尿液更宜被模拟为一种真正的平衡状态，而非过饱和/亚稳态，并且游离柠檬酸根离子在维持固体颗粒的分散（减少团聚）方面起主要作用。已发表的尿液化学数据，结合计算机程序SEQUIL，被用于制定一种独立于结石形成者传统临床分类的新型钙结石形成风险指数。将该风险指数应用于39名未经治疗的钙结石形成者连续三天的24小时尿液样本，结果显示35名（90%）患者至少有一次尿液异常。传统的单一尿液参数评估，即钙/肌酐、草酸盐/肌酐或柠檬酸盐/肌酐比值，分别显示只有17%、14%和18%的患者存在异常，而将这三项综合起来看时，24名（70%）患者存在某种异常，因此30%为“特发性”结石形成者。已使用该计算机程序设计出治疗方案，以便根据所提出的风险指数将异常尿液恢复至正常状态。在大多数尿液中必须同时改变两个或更多因素。临床上在36个月内仅有1例复发，而此前他们每3年复发4.4次。
