1878例上尿路结石成分和发病年龄随时间变迁的横断面研究

Temporal alteration of stone composition and onset age in the upper urinary tract： a cross-sectional study of 1 878 cases

目的 探讨2003-2014年上尿路结石类型构成和发病年龄的变化.方法 对2003-2014年在我院诊治的1 878例上尿路结石患者开展横断面研究.男1 300例,女578例,发病年龄6～95岁,平均46岁.采用红外光谱分析法测定结石成分.按发病时间将病例分为2003-2006年、2007-2010年、2011-2014年3组.采用x2检验比较3组的结石类型构成,对尿酸结石比例的单因素分析采用趋势x2检验,多因素分析采用Logistic多元回归,并对尿酸结石比例与年份行简单线性回归分析,采用Kruskal-Wallis检验比较3组的发病年龄.结果 1 878例结石以草酸钙结石为主,占78.1％（1 466例）,尿酸结石占4.8％（91例）.3组中,草酸钙结石均占主要构成,余下依次为磷酸盐结石、尿酸结石和其他类型结石,总体上结石类型构成的差异无统计学意义（P =0.087）.但3组的尿酸结石比例依次为2.7％（12例）、5.1％（39例）和5.9％（40例）,呈逐年上升的趋势（P＜0.05）,多元回归分析显示年份组对应的OR为1.385（95％CI1.027～1.867）.从2003年至2014年,尿酸结石的比例每年平均增高0.42％ （95％ CI0.25％ ～0.59％）.3组平均发病年龄依次为43、46和49岁,呈逐渐增高趋势（P＜0.01）.结论 2003-2014年,我国上尿路结石患者中尿酸结石的比例和发病年龄可能呈增高趋势.

Objective To investigate if distribution of stone composition and onset age in the upper urinary tract changed during the past 12 years in China.Methods There were 1 878 urolithiasis patients of the upper urinary tract in our hospital from 2003 to 2014 enrolled in present cross-sectional study.There were 1 300 male and 578 female patients with a median onset age of 46 （6-95） years.Stone composition was measured by infrared spectrophotometry.All the patients were divided into 3 groups according to the onset year：Year 2003-2006,Year 2007-2010 and Year 2011-2014.The distributions of stone types were compared among the 3 groups.Age and gender were included as potential confounders.Chi square test,P trend test,Kruskal-Wallis test and logistic regression were employed in the statistical analysis.Results Calcium oxalate was the most common type with a dominant proportion of 78.1% （1 466/1 878）,while uric acid had a small proportion of 4.8% （91/1 878）.The proportions of uric acid in the 3 groups were 2.7% （12/441）,5.1% （39/758） and 5.9% （40/679）,showing an increasing trend （P 〈0.05）.Multivariate analysis showed that year group was independently correlated with the proportion of uric acid,with an OR of 1.385 （95% CI,1.027-1.867）.From 2003 to 2014,the proportion of uric acid calculus increased by 0.42% （95% CI,0.25%-0.59%） annually.The median ages of disease onset were 43,46 and 49 years respectively in those three groups,also showing an increasing trend with time （P 〈0.01）.Conclusion From 2003 to 2014,the proportion of uric acid and onset age in patients of upper urinary tract calculi were increased in the present cohort.