Thiosulfate Reduces Calcium Phosphate Nephrolithiasis
Thiosulfate Reduces Calcium Phosphate Nephrolithiasis
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DOI：
10.1681/asn.2008070754
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发表时间：
2009-06-01
影响因子：
13.6
通讯作者：
Bushinsky, David A.
中科院分区：
文献类型：
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作者：
Asplin, John R.;Donahue, Susan E.;Bushinsky, David A.
一项非对照试验报告称，硫代硫酸钠可减少人体钙肾结石的形成，但这一点尚未在对照人体研究或动物模型中确立。利用遗传性高钙尿症大鼠（一种磷酸钙结石形成的动物模型），我们研究了硫代硫酸钠对尿化学和结石形成的影响。我们喂养遗传性高钙尿症大鼠正常的食物与硫代硫酸钠或不含18周，并测量尿液化学，过饱和度，和上限的亚稳态的尿液。12只未处理的大鼠中有11只形成结石，而12只硫代硫酸盐处理的大鼠中只有3只形成结石（P < 0.002）。硫代硫酸盐处理的大鼠尿钙和磷较高，尿柠檬酸盐和尿量较低，这些变化将增加磷酸钙过饱和。硫代硫酸盐治疗降低了尿液pH值，这将降低磷酸钙过饱和度。总体而言，硫代硫酸盐处理组和对照组大鼠之间的磷酸钙过饱和度或亚稳性上限无统计学显著差异。在体外，硫代硫酸盐对离子钙的影响最小，表明其作用机制不同于钙螯合作用。总之，硫代硫酸钠可减少遗传性高钙尿大鼠磷酸钙结石的形成。需要对硫代硫酸钠治疗人类复发性肾结石的有效性和安全性进行对照试验。
An uncontrolled trial reported that sodium thiosulfate reduces formation of calcium kidney stones in humans, but this has not been established in a controlled human study or animal model. Using the genetic hypercalciuric rat, an animal model of calcium phosphate stone formation, we studied the effect of sodium thiosulfate on urine chemistries and stone formation. We fed genetic hypercalciuric rats normal food with or without sodium thiosulfate for 18 wk and measured urine chemistries, supersaturation, and the upper limit of metastability of urine. Eleven of 12 untreated rats formed stones compared with only three of 12 thiosulfate-treated rats (P < 0.002). Urine calcium and phosphorus were higher and urine citrate and volume were lower in the thiosulfate-treated rats, changes that would increase calcium phosphate supersaturation. Thiosulfate treatment lowered urine pH, which would lower calcium phosphate supersaturation. Overall, there were no statistically significant differences in calcium phosphate supersaturation or upper limit of metastability between thiosulfate-treated and control rats. In vitro, thiosulfate only minimally affected ionized calcium, suggesting a mechanism of action other than calcium chelation. In summary, sodium thiosulfate reduces calcium phosphate stone formation in the genetic hypercalciuric rat. Controlled trials testing the efficacy and safety of sodium thiosulfate for recurrent kidney stones in humans are needed.