Absence of Oxalobacter formigenes in cystic fibrosis patients:: A risk factor for hyperoxaluria
Absence of Oxalobacter formigenes in cystic fibrosis patients:: A risk factor for hyperoxaluria
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DOI：
10.1016/s0140-6736(98)03038-4
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发表时间：
1998-09-26
期刊：
影响因子：
168.9
通讯作者：
Peck, AB
中科院分区：
文献类型：
--
作者：
Sidhu, H;Hoppe, B;Peck, AB
囊性纤维化患者发生高尿酸血症、肾钙质沉着症和草酸钙尿石症的风险增加。草酸盐体内平衡部分由肠道细菌产草酸杆菌控制。该细菌从肠道植物群的丧失与高尿酸和草酸钙尿石症的风险增加有关。我们调查是否缺乏O型产甲酸菌和高尿酸的存在相关的囊性纤维化（CF patients.Methods 43例CF患者，年龄3-9岁，从21名年龄相仿的健康志愿者粪便标本进行检测O型产甲酸菌培养和DNA分析。在同一时间，24小时尿样收集和分析草酸盐和其他因素，促进或抑制结石形成。结果15（71%）的21名健康志愿者，但只有7（16%）的43 CF患者的O formigenes殖民。在这7名患者中，有6名检测到产甲酸杆菌，需要基于DNA的鉴定，这表明菌落形成单位数量较少，而具有正常产甲酸杆菌数量的CF患者是43名未接受抗生素治疗的患者中唯一一名。所有7名携带O型产甲酸菌的CF患者尿草酸水平正常，但36名未携带O型产甲酸菌的患者中有19名（53%）患有高尿酸血症，其中最严重的高尿酸血症发生在年轻患者中。（例如，肾钙质沉着症、尿石症）、抗生素的长期广泛使用以及CF中发生的胃肠道改变，可能导致CF患者永久性去定居。
Background Patients with cystic fibrosis have an increased risk of hyperoxaluria, and of subsequent nephrocalcinosis and calcium-oxalate urolithiasis. Oxalate homoeostasis is controlled, in part, by the intestinal bacterium, Oxalobacter formigenes, The loss of this bacterium from the gut flora is associated with an increased risk of hyperoxaluria and calcium-oxalate urolithiasis. We investigated whether the absence of O formigenes and the presence of hyperoxaluria are correlated in cystic fibrosis (CF) patients.Methods Stool specimens from 43 patients with CF aged 3-9 years and from 21 similarly aged healthy volunteers were examined for O formigenes by culture and DNA analysis. At the same time, 24 h urine samples were collected and analysed for oxalate and other factors that promote or inhibit stone formation.Findings 15 (71%) of 21 healthy volunteers but only seven (16%) of 43 CF patients were colonised with O formigenes. Detection of O formigenes in six of these seven patients required DNA-based identification, suggesting low numbers of colony-forming units, and the CF patient with normal numbers of O formigenes was the only one of the 43 patients who had not been treated with antibiotics. All seven CF patients colonised with O formigenes had normal urinary oxalate levels, but 19 (53%) of 36 patients not colonised with O formigenes were hyperoxaluric, with the most severe hyperoxaluria occurring in young patients.Interpretation Absence of O formigenes from the intestinal tract of CF patients appears to lead to increased absorption of oxalate, thereby increasing the risk of hyperoxaluria and its complications (eg, nephrocalcinosis, urolithiasis), Prolonged widespread use of antibiotics, and alterations of the gastrointestinal tract that occur in CF, may induce a permanent decolonisation in CF patients.