Pak C Y
Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Tex. 75235-8885, USA.
Nephron. 1999;81 Suppl 1:60-5. doi: 10.1159/000046300.
Medical treatment designed to prevent stone formation is important in idiopathic calcium oxalate nephrolithiasis, because of the high rate of stone recurrence. Several randomized trials have established the values of conservative and drug treatments. A high fluid intake alone has been reported to inhibit the recurrence of stone formation in single stone formers. In patients with recurrent disease, a significant reduction in stone formation rate from pretreatment was found in the placebo group maintained on a conservative program, underscoring the importance of increased fluid intake and dietary modification. In patients with active recurrent stone disease, treatment with drugs along with a conservative program is necessary. Allopurinol, thiazide, potassium citrate and potassium-magnesium citrate have been shown to inhibit stone formation compared with placebo. It has not been clearly established that a selective treatment is more effective than a more randomly chosen drug treatment. Another advantage of medical approach is its ability to correct nonrenal complications of stone disease, such as bone loss that sometimes accompanies stone disease.
由于草酸钙结石复发率高，旨在预防结石形成的医学治疗在特发性草酸钙肾结石中很重要。多项随机试验确定了保守治疗和药物治疗的价值。据报道，仅大量饮水就能抑制单发结石患者结石形成的复发。在复发性疾病患者中，接受保守治疗方案的安慰剂组结石形成率较治疗前显著降低，这突出了增加饮水量和饮食调整的重要性。对于活动性复发性结石疾病患者，药物治疗与保守治疗方案相结合是必要的。与安慰剂相比，别嘌醇、噻嗪类、柠檬酸钾和枸橼酸钾镁已被证明能抑制结石形成。目前尚未明确证实选择性治疗比随机选择的药物治疗更有效。医学治疗方法的另一个优点是它能够纠正结石疾病的非肾脏并发症，如有时伴随结石疾病出现的骨质流失。
