患有和不患有肠性高草酸血症的草酸钙结石形成者的风险特征、营养摄入和肾功能的比较。一项配对病例对照研究

摘要(中文译文)

本研究比较了伴有和不伴有肠源性高草酸尿症的草酸钙结石形成者的风险特征、营养素摄入及肾功能。研究纳入37例草酸钙结石病合并肠源性高草酸尿症患者（病例组）和37例性别、年龄匹配的特发性草酸钙结石形成者（对照组）。患者在研究开始前未接受任何营养指导，并在参与研究前四周停用影响尿液参数的药物。记录人体测量学、临床及代谢参数。在习惯饮食和均衡标准化饮食下测量膳食及24小时尿液变量。进行[碳-13]草酸吸收试验和钙负荷试验。病例组[碳-13]草酸吸收中位数（14.8%）显著高于对照组（8.9%）。在均衡饮食下，病例组低枸橼酸尿、低镁尿、尿量减少及尿pH值降低显著更为常见，而高钙尿在对照组中更常见，影响45.9%的对照者和5.4%的病例。此外，对照组在均衡饮食下尿钙排泄下降幅度更大。两种饮食下尿草酸排泄及草酸钙离子活度乘积指数均显著升高，均衡饮食下病例组下降幅度更大。病例组估算肾小球滤过率（eGFR）较低。多变量线性回归分析显示尿pH与eGFR之间存在显著关联。伴有和不伴有肠源性高草酸尿症的草酸钙结石形成者均可从均衡饮食和充足液体摄入中获益。肠源性高草酸尿症患者尿草酸排泄的减少及草酸钙结石复发生化风险的降低更为明显。应特别关注低尿pH值，因其被推测为肾功能受损的潜在指标。

Abstract

: This study compared the risk profiles, nutrient intake, and kidney function of calcium oxalate stone formers with and without enteric hyperoxaluria. : Thirty-seven patients with calcium oxalate stone disease and enteric hyperoxaluria (cases) and 37 sex- and age-matched idiopathic calcium oxalate stone formers (controls) were enrolled. Patients did not receive any nutritional counseling prior to the start of the study, and they discontinued medications affecting urinary parameters four weeks before their study participation. Anthropometric, clinical, and metabolic parameters were recorded. Dietary and 24-h urinary variables were measured under the habitual diet and under a balanced, standardized diet. The [C] oxalate absorption and calcium loading tests were carried out. : The median [C] oxalate absorption was significantly higher in cases (14.8%) than in controls (8.9%). Under the balanced diet, hypocitraturia, hypomagnesuria, low urine volume and pH value were significantly more common in the case group, whereas hypercalciuria occurred more frequently in the control group, affecting 45.9% of controls and 5.4% of cases. Furthermore, the control group exhibited a greater reduction in urinary calcium excretion under the balanced diet. Urinary oxalate excretion and the ion-activity product index of calcium oxalate were significantly higher under both diets, with a greater decline observed in the case group under the balanced diet. The estimated glomerular filtration rate (eGFR) was lower in cases. A multivariable linear regression analysis revealed a significant association between urine pH and eGFR. : Calcium oxalate stone formers with and without enteric hyperoxaluria benefit from a balanced diet and sufficient fluid intake. The reduction in urinary oxalate excretion and the biochemical risk of recurrent calcium oxalate stone formation were even more pronounced in patients with enteric hyperoxaluria. Particular attention should be paid to low urine pH, as it is hypothesized to be a potential indicator of impaired kidney function.

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