尿路結石症におけるクエン酸療法の臨床的検討-尿路結石症患者のクエン酸排泄量の検討とクエン酸製剤による治療効果の検討

• Published in: 日泌尿会誌 Vol. 79; pp. 620 - 628
• Main Author: 安川修
• Format: Journal Article
• Language: Japanese
• Published: 社団法人日本泌尿器科学会 1988; The Japanese Urological Association
• ISSN: 0021-5287

1. クエン酸リアーゼを用いた酵素法による測定で正常健康人109例,及びカルシウム結石患者231例の尿中クエン酸排泄量について検討し以下のような結果が得られた. 1)健康人男子72例,および女子37例の尿中クエン酸排泄量は383.9±156.5mg/day,および452.6±171.4mg/dayであり,女子の方が5%の危険率で有意に高値を示した.また,カルシウム結石群では男子326.2±203.6mg/day,女子374.2±219.7mg/dayであり,男子は5%の危険率で低値を示し,女子は結石再発群のみが有意な低値を示した. 2)健康人の男女の排泄量の統計学的検討により,クエン酸排泄量の正常下限値を男子200mg/day,女子250mg/dayとして低クエン酸尿症を定義したところ,結石群では男女とも約30%の低クエン酸尿症が認められた. 3)過カルシウム尿症あるいは過蓚酸尿症と低クエン酸尿症の合併は,いずれも結石群の10%前後に過ぎなかった. 4)尿中クエン酸排泄量と尿量,尿中マグネシウム,尿酸,リンおよび蓚酸排泄量の間には弱い正の相関を示す傾向が認められた. 2. カルシウム結石患者に対し,クエン酸剤を1日3gを経口投与し,尿中パラメーターの追跡検討を行ったところ尿pHと尿中クエン酸排泄量の有意な上昇の持続が観察された.また6ヵ月以上の投与症例での検討では結石再発防止効果が予想される結果が得られた. 1. Calcium stone formers (male;170, female;61) and healthy controls (male;72, female;37) were examined with respect to urinay citrate and several urinary biochemistries. Urinary citrate was determined using an enzymatic method which we had reported. The following results were obtained: 1) The mean value of urinary citrate excretion was 383.9±156.5 mg/day in male controls, and 452.6±171.4 mg/day in female controls. In healthy controls, urinary citrate in females was significantly higher than in males (p<0.05). 2) In male patients with calcium urolithiasis urinary citrate was significantly lower than the healthy controls. In female patients urinary citrate excretion was significantly lower only in the group of recurrent stone formers. 3) Hypocitraturia was defined when citrate excretion was under 200 mg/day in males and under 250 mg/day in female. According to this definition, 45 of 116 male patients (26.5%) and 17 of 61 female patients (27.9%) were classified to hypocitraturia. 4) Hypocitraturia was associated with hypercalciuria in 12.4 per cent of male stone formers, and in 6.6 per cent of female stone formers. Both of hypocitraturia and hyperoxaluria were found in only about 10 per cent of stone formers in both sexes. These results showed that hypocitraturia itself was one of the serious risk factors of stone formation. 5) There were low statistical correlation between urinary citrate and urine volume, urinary magnesium, uric acid, phosphorus or oxalate. Urinary citrate was correlated with urinary calcium only in stone formers and was not correlated with urinary pH. 2. Citrate therapy with sodium-potassium-citrate (CG-120) was performed in 31 calcium stone formers. During the therapy urinary citrate excretion was significantly increased and the effect was sustained. Of 23 patients, who have received citrate therapy for at least 6 months, only two patients had recurrence of stones after treatment. Citrate therapy was considered to be useful for preventing the recurrence of calcium urolithiasis.