枸橼酸氢钾钠在大负荷肾尿酸结石治疗中的应用(附6例报告并文献复习)

目的探讨枸橼酸氢钾钠在大负荷肾尿酸结石治疗中的效果。方法回顾性分析2018年1月至2020年7月天津医科大学第二医院以枸橼酸氢钾钠治疗的6例大负荷肾尿酸结石(长径>4cm)患者的临床资料。患者均为男性,平均年龄51.3(42~66)岁,平均结石长径6.0(4.1~7.6)cm,腹部X线片(KUB)阴性,平均CT值475(418~535)HU,治疗前尿pH均≤5.5。6例血尿酸平均453.3(258.7~570.0)μmol/L,其中3例高于正常值,3例有痛风病史;2例有肾结石手术病史,结石成分回报为无水尿酸,其余4例根据病史及影像学检查诊断为尿酸结石。所有患者均无泌尿系感染病史及泌尿系梗阻。6例均予口服枸橼酸氢钾钠颗粒治疗,以10g/d为起始剂量,按早餐后2.5g、午餐后2.5 g、晚餐后5.0 g分次服用,根据尿液pH值调整剂量,保持尿pH值6.5~7.0。治疗期间每2~3个月复查CT平扫以评价治疗效果。结果6例治疗2.5~8.0个月,无明显胃肠道不适等不良反应。结石负荷均有不同程度降低,平均长径缩短3.2(1.4~5.9)cm,其中2例结石基本消失。枸橼酸氢钾钠治疗后复查CT示,结石边缘由光滑变粗糙,结石表面及内部出现虫蚀样缺损及空洞,表现出明显的溶石现象。结论枸橼酸氢钾钠对大负荷肾尿酸结石具有较好的治疗效果。对于临床考虑尿酸结石的非感染患者可尝试应用枸橼酸氢钾钠治疗。

Application of potassium sodium hydrogen citrate in the treatment of renal uric acid calculi with heavy load and literature review

Objective To investigate the effect of potassium sodium hydrogen citrate in the treatment of renal uric acid calculi with heavy load.Methods The clinical data of 6 patients with intrarenal high-load uric acid calculi(long diameter>4 cm)treated with potassium sodium hydrogen citrate in our hospital from January 2018 to July 2020 were reviewed.All of the patients were male.Their ages ranged from 42 to 66 years,with an average age of 51.3 years old.The average length to diameter was 6.0(4.1-7.6)cm.The average density of stone was 475(418-535)HU.The average blood uric acid was 453.3(258.7-570.0)μmol/L,and all patients had a urine pH≤5.5.The blood uric acid level was higher than normal serum uric acid level before treatment,and 3 cases had a history of gout.Stone composition analysis revealed 100%uric acid stone in two patients before treatment.The remaining patients were more likely to have uric acid calculi before treatment.None of the patients had a history of urinary tract infection.All patients were treated with oral potassium sodium hydrogen citrate.During the treatment,the starting dose was 10g/day,which was divided into 2.5 g after breakfast,2.5 g after lunch and 5.0 g after dinner.The dose was adjusted according to the pH value of urine,and the urine pH was maintained between 6.5-7.0.CT plain scan was repeated every 2-3 months during the treatment period to evaluate the treatment effect.Result After 2.5-8.0 months’treatment,the stone load of all the patients was reduced to different degrees,and the average length diameter was shortened by 3.2cm,among which two patients’stones disappeared.CT scan showed the stone edge changed from smooth to rough after the treatment,and there would be worm erosion defect and cavity on the surface and inside of the stone,showing obvious stone dissolution phenomenon.Conclusions Potassium sodium hydrogen citrate has a good therapeutic effect on renal uric acid calculi with heavy load.Non-infected patients with uric acid calculi should be treated with potassium sodium hydrogen citrate.