小儿上尿路结石代谢评估及其临床意义探讨

Clinical analysis and significance of urine metabolism for pediatric upper urinary calculi

目的探讨小儿上尿路结石代谢评估的意义。方法回顾性对比分析2012年7月至2014年2月住院的尿石症患儿169例（尿石症组）与非尿石症组（泌尿系B型超声未发现泌尿系结石患儿）163例的临床资料，包括：患儿的空腹血液生化、24h尿生化结果，并行结石成分分析，分析两组代谢相关指标差异及结石患儿结石成分特点。结果尿石症组与非尿石症组血液生化结果对比，差异无统计学意义（P〉0．05）。尿石症组24h尿钙水平为（6．65±1．45）mg／kg，非尿石症组为（2．79±1．06）mg／kg，组间比较，差异有统计学意义（P〈0．05）。尿石症组24h尿镁水平为（0．77±0．22）mg／妇，非尿石症组为（2．71±0．66）mg／妇，差异有统计学意义（P〈O．05）。尿石症患儿中有高钙尿症者98例（58％），低镁尿症者46例（27％）。小儿上尿路结石成分主要为草酸钙结石125例（74％），其次为鸟粪石27例（16％），磷酸钙14例（8％）等。结论小儿尿石症与多种代谢因素有关，其中高钙尿症及低镁尿症是最常见的代谢异常，结石主要成分为草酸钙，其原因及干扰措施有待进一步研究探索。

Objective To explore the clinical analysis and significance of urine metabolism for pediatric upper urinary calculi. Methods The clinical data from our hospital from July 2012 to February 2014 were reviewed. A total of 169 patients had upper urinary calculi while another 163 patients were diagnosed as non-urolithiasis. Blood and urine specimens were collected the next morning after admission. Blood biochemistry, 24-hour urine biochemistry and stone composition were measured by automatic biochemistry analyzer. Results No inter-group difference existed in age or gender （P〉 0. 05）. And there were inter-group differences in the urinary levels of calcium and magnesium （P~ 0. 05）. The results of urinalysis in urolithiasis： hypercaleiuria （n = 98, 58%） and hypomagnesiuria （n = 46, 27%）. Stone analysis （n= 169） ： calcium oxalate stone （n = 125, 74%）, struvite stone （n = 27, 16%） and calcium phosphate stone （n = 14, 8%）. Conclusions Pediatric urolithiasis have close correlations with such metabolic factors as hypercalciuria and hypomagnesiuria. Calcium oxalate stone is the most frequent type. Further studies are needed for elucidating the causes and countermeasures of pediatric urolithiasis.