广东东莞地区416例泌尿系结石成分分析

Composition analysis of urolithiasis for 416 cases of Dongguan area

目的 应用红外光谱法测定东莞地区泌尿系结石化学成分,探讨本地区泌尿系结石患者的尿路结石成分特点,为本地区泌尿系结石的深化治疗、防止结石复发及预防提供科学依据.方法 收集经自行排出、碎石后排出或手术中取出的泌尿系结石标本416例,应用溴化钾压片技术的红外光谱法对其化学成分进行定性分析.结果 416例泌尿系结石患者中男性居多,占66.8%（278/416）,女性占33.2%（138/416）;上尿路结石占88.2%,下尿路结石（膀胱结石居多）占11.8%;结石成分定性分析共检测出一水草酸钙、二水草酸钙、碳酸磷灰石、无水尿酸、六水磷酸铵镁和尿酸铵6种化学成分.单一成分结石163例（一水草酸钙/无水尿酸/碳酸磷灰石/六水磷酸铵镁：98/56/6/3）,占39.2%;混合成分结石253例,占60.8%,其中以草酸钙和碳酸磷灰石的混合结石为主（188/253）.所有结石标本中草酸钙检出率最高,占80.5%（335/416）,其次为碳酸磷灰石（49.3%）及无水尿酸（17.3%）;膀胱结石成分以一水草酸钙或无水尿酸为主.结论 东莞为全国泌尿系结石最高发地区,其结石成分以草酸钙和碳酸磷灰石为主,单一成分结石亦占相当比例.尿路结石成分分析对了解结石成因可提供重要的线索,对临床制定个性化治疗方案、预防结石形成及复发具有重要意义.

Objectives To analyze the chemical constituents of urolithiasis in Dongguan area and to provide reference for the prevention and treatment of urolithiasis.Methods A total of 416 samples of urolithiasis discharged from our hospital after the extracorporeal shock wave lithotripsy or removed from the inpatients through surgery were collected and analyzed with infrared spectroscopy.Results Among 416 cases of urolithiasis, the upper urinary tract calculus was 88.2% ,and the lower urinary tract calculus was accounted for 11.8%, 66.8% （278/416） for men, 33.2% （138/416） for women.Six chemical components were analyzed,including calcium oxalate monohydrate, calcium oxalate dihydrate, carbonate apatite, anhydrous uric acid, hexahydrate magnesium ammonium phosphate and ammonium urate.A total of 163 cases as a single component, accounting for 39.2%, and 253 cases were mixed components, accounting for 60.8%.Among them, calcium oxalate and calcium carbonate were the main stones（188/253）.The detection rate of calcium oxalate was the highest in all stone samples, accounting for 80.5% （335/416）, followed by carbonate apatite （49.3%） and anhydrous uric acid （17.3%）.The chemical composition of urinary bladder stones was mainly of calcium oxalate or uric acid.Conclusions Dongguan area is the highest incidence of urinary stones in China, calcium oxalate and calcium carbonate were the main stones.Single component stones also accounts for a considerable proportion.Composition analysis of urinary calculi can provide important clues for understanding the origin of stone,It also has important significance for the clinical development of individualized treatment plan, prevention of stone formation and recurrence.