妊娠期合并泌尿系结石的临床分析

Clinical analysis of urolithiasis in pregnancy

目的 探讨妊娠期合并泌尿系结石的相关因素及与妊娠结局的关系. 方法 回顾性分析2004年1月至2009年12月收治的162例（A组）妊娠期合并泌尿系结石患者的资料,患者年龄18～41岁,平均（24±5）岁.孕前有泌尿系结石病史7例.选取同期妊娠无结石妇女150例（B组）,平均年龄（23±5）岁;育龄期无妊娠无结石妇女150例（C组）,平均年龄（24±4）岁.比较3组血生化、电解质及尿生化检查指标的差异.A组162例中,症状性结石119例,其中接受外科治疗24例、保守治疗95例,比较两组患者胎儿流产率、早产率和剖宫产率的差异. 结果 A、B、C组的血白细胞分别为（11.39±3.89）、（10.78±2.98）、（6.21±1.48）×109/L,血尿酸分别为（331.12±215.22）、（329.32±88.50）、（280.01±69.88） μmol/L,尿蛋白分别为（0.29±2.00）、（0.10±0.19）、（0.02±0.09）mmol/L,尿葡萄糖分别为（2.50±8.44）、（2.35±8.63）、（0.25±1.97） mmol/L,尿红细胞分别为（76.60±98.11）、（77.43±71.00）、（13.77±37.93）个/高倍镜,A、B组与C组比较差异均有统计学意义（P＜0.05）.A组的尿白细胞[（145.16±202.18）个/高倍镜]和尿酮体[（2.41±6.14） mmol/L]与B组[（46.00±119.50）个/高倍镜和（0.30±1.75） mmol/L]、C组[（55.33±145.36）个/高倍镜和（0.17±1.26）m mol/L]比较差异有统计学意义（P＜0.05）.119例症状性结石患者中,保守治疗组与外科治疗组各有l例胎儿流产（1.1％与4.2％）,早产率分别为5.3％与0,剖宫产率分别为17.9％与4.2％. 结论 妊娠期妇女血白细胞、血尿酸、尿蛋白、尿葡萄糖及尿红细胞明显高于同期非妊娠妇女,但与妊娠尿路结石形成的关系并不明确.妊娠合并泌尿系结石妇女尿白细胞及酮体升高,提示尿路结石的形成可能与孕妇尿路感染及代谢有密切关系.外科干预会增加胎儿流产的风险.

Objective To analyze the risk factors of urolithiasis in pregnancy and the relationship between urolithiasis in pregnancy and pregnancy outcomes.Methods From January 2004 to December 2009,the clinical data of 162 pregnant women （Group A）,diagnosed as upper urinary tract calculi,were reviewed,retrospectively.Their age ranged from 18 to 41 years （mean 24±5 years）.Seven of them had history of urolithiasis before pregnant.At the same time,150 pregnant women without urinary stone （Group B） were also included in this study,whose mean age was 23±5 years.In addition,150 women without pregnant and urinary stone （Group C） were included in this study,whose mean age was 24±4 years.The blood and urine routine results,blood uric acid and electrolytes were recorded and compared among those groups.In group A,119 cases had symptomatic urolithiasis.Surgical intervention was performed in 24 cases and the conservative therapy was performed in 95 cases.The rates of abortion,premature delivery and cesarean delivery were compared between two groups.Results Compared group A with group B and group C,there were significant differences in the urine WBC （145.16±202.18 vs.46.00± 119.50 and 55.33 ± 145.36 per high power lens） and urine ketone body （2.41 ± 6.14 mmol/L vs.0.30± 1.75 mmol/L and 0.17± 1.26 mmol/L） （P〈0.05）.Meanwhile,there were significant differences in the blood leukocytes [（11.39±3.89）× 109/L,（10.78±2.98） ×109/L vs.（6.21±1.48） × 109/L],the blood uric acid （331.12±215.22 μmol/L,329.32± 88.50 μmol/L vs.280.01±69.88 μmol/L）,the urine protein （0.29±2.00 mmol/L,0.10±0.19 mmol/L vs.0.02±0.09 mmol/L）,urine glucose （2.50±8.44 mmoL/L,2.35±8.63 mmol/L vs.0.25± 1.97 mmol/L） and urine erythrocyte （76.60±98.11,77.43±71.00 vs.13.77±37.93 per high power lens） （P〈0.05）.In those patients with symptomatic urolithiasis,there was 1 case of abortion in the conservative treatment and surgery intervention groups,respectively.The premature delivery rate and cesarean delivery rate were 5.3% vs.0% and 17.9% vs.4.2%,respectively.Conclusions The blood leukocytes,blood uric acid,urine protein,urine glucose and urine erythrocytes are significantly high in pregnant women than those in non-pregnant women.However,the relationship between those abnormality and urolithiasis in pregnancy is still indefinite.Since the urine leukocytes and ketone increase obviously,it might suggest that the occurrence of the urine calculi is related with the metabolism of nourishment and electrolytes,urinary tract infection in pregnancy.The surgery intervention may be a risk of fetus miscarriage.