上部尿路結石の成因に関する研究 - 尿路結石形成危険因子の検討 -

Abstract

京大泌尿器科に1984年4月から1年間に入院した上部尿路結石患者で, Ca含有結石と推定した男子患者中多発性あるいは再発性結石23例, 単発性結石患者13例, 対照群21例に, Ca・P一定食を3日間摂取させ, その前後24時間尿(24尿)中のCa, P, Mg, 尿酸, 蓚酸, クエン酸を定量し, 体表面積との比を算定し3群間で比較検討した.1) 24尿中Ca排泄量とこの体表面積補正値は結石患者に高い傾向をみ, 一定食摂取後に低下傾向をみるが有意ではなかった.2) 24尿中Mg排泄量とこの体表面積補正値は再発多発性結石例に低い傾向をみ, 一定食摂取後, 低下傾向をみたが有意ではなかった.Mg/Ca濃度比(%)は, 結石患者群, 対照群を問わず24尿中Ca排泄量と有意に逆相関した.3) 24尿中クエン酸排泄量は, 多発性結石群で有意に低値を示した.4)尿中の上記6項目中, 多発性結石群に異常項目を多くみ, 上部尿路結石形成は多くの異常値の集積の結果と考える

Various risk factors and inhibitors of the stone formation of the upper urinary tract have been pointed out in urine. We examined the amount of daily excretion of several important risk factors (calcium, phosphorus, urate and oxalate) and inhibitors (magnesium and citrate) in the urine of 21 healthy males, 13 male single stone formeks and recurrent and/or multiple stone formers before and after taking the regular diet which contains 500 mg of calcium and 1, 000 mg of phosphorus a day. The daily excretion of calcium, phosphorus and magnesium indicated no significant differences among the 3 groups. The excretion of oxalate in urine for 24 hours was significantly decreased in the stone formers after taking the regular diet. The urinary excretion of the urate per body surface area in the stone formers was significantly higher than that in the healthy control. The amount of the excretion of the citrate in urine in the recurrent and/or multiple stone formers was significantly lower than that in the other 2 groups. Many patients of the recurrent and/or multiple urinary stones had more than two abnormal values of above-mentioned risk factors and inhibitors. These results suggest that the causes of the formation of the upper urinary stone were not single but multiple and that the dietary advice to these patients was important against the recurrence of the urolithiasis.