肾脏结石成分与尿液部分理化指标检测的结果分析

Analysis of the renal calculus composition and urine physical and chemical indexes

目的 探讨新疆地区不同类型结石在肾脏结石患者中所占比例,分析结石成分与尿液理化性质和蛋白构成之间的关系.方法 病例对照研究.纳入2014年3月至2016年11月期间在新疆维吾尔自治区人民医院住院治疗的355例肾脏结石患者,以及同期非泌尿系统疾病住院并且排除其他疾病或并发症导致的肾损害患者30例为对照组.对结石成分进行分析,根据结石主要成分划分为草酸盐组、碳酸磷组、尿酸组和磷酸盐组,并对患者24 h尿液部分理化性质和蛋白构成,采用离子选择电极法、速率法、酶法和免疫比浊法进行检测分析.两样本间均数差异性分析采用t检验,多样本间两两比较采用F检验和LSD-t检验,构成比的差异比较采用卡方检验.结果 355例结石样本中,以222例混合性结石为主,占62.5%,其中又以草酸盐结石为主169例,占76.1%;单纯性结石133例,占37.5%,其中又以草酸盐结石为主75例,占56.4%.与对照组（30例）比较,草酸盐组（244例）尿液pH（5.33±0.32）明显降低,24 h尿钙和24 h尿尿酸[（7.68±0.35）mmol、（3.48±0.23）mmol]水平明显升高,24 h尿镁（3.02±0.29）mmol明显降低（t值均〉5.874,P〈0.05）;磷酸盐组（23例）尿液pH（6.98±0.77）升高,24 h尿磷（10.55±0.63）mmol水平降低,24 h尿钙（7.96±0.57 ）mmol水平升高（t值均〉9.436,P〈0.05）,伴有高尿钙症的结石患者23例,占到69.6%;尿酸组（61例）尿液pH水平低至（4.97±0.48）,且49例患者伴有尿液过度酸化,占80.3%,24 h尿尿酸含量（4.14±0.37 ）mmol明显升高（t=11.459,P〈0.05）,伴有高尿酸尿症的患者31例占50.8%;碳酸磷组（23例）尿液pH（6.86±0.68）升高（t=6.876,P〈0.05）;此外,草酸盐组尿半胱氨酸蛋白酶抑制剂C（0.653±0.148）mg/L、尿α1微球蛋白（1.53±0.56）mg/dl和尿β2微球蛋白（0.585±0.088）mg/L水平明显升高（t值均〉8.442,P〈0.05）.结论 肾脏结石成分和相应尿液代谢变化之间可能具有相关性.

Objective To explore the proportion of different types of stones in patients with kidney stones in Xinjiang, and to analyze the relationship between stone composition and urine physicochemical properties and protein composition.Methods Through a case-control study, 355 patients with kidney stones who were hospitalized in the Xinjiang Uygur Autonomous Region People′s Hospital from March to November 2010 were enrolled in the same period, and non-urinary tract diseases were hospitalized and excluded from other diseases or complications of the 30 cases of renal impairment in the control group.The composition of the stones was analyzed.The main components of the stones were divided into oxalate group, carbonic acid group, uric acid group and phosphate group.The physicochemical properties and protein composition of 24 h urine were analyzed by ion selective electrode method, enzymatic and immunoturbidimetric assay.The difference between the two samples was analyzed by t test, and the differences between the two groups were analyzed by F-test and LSD-t test.Results Compared with the control group（30 cases）, urine pH（5.33±0.32） was significantly lower in the oxalate group （244 cases）, 24 h urinary calcium and 24 h uric acid[（7.68±0.35） mmol, （3.48±0.23）mmol （pH=5.874,P〈0.05）].The urine pH （6.98±0.77） was increased in the phosphate group （23 cases）, and the 24 h urinary magnesium （3.02±0.29） mmol was significantly lower than in the control group （10.56±0.63） mmol, and the level of 24 h urinary calcium （7.96±0.569） mmol increased （t〉9.436, P〈0.05）.There were 23 patients with calcineuria （P〈0.05）.The urine pH level in the uric acid group （61 cases） was as low as （4.97±0.48）, and 49 patients were accompanied by excessive acidification （80.3%） and 24 h uric acid （4.14±0.37） mmol （t=11.459,P〈0.05）.And the urine pH （6.86±0.68） was higher in the phosphate group （n=23） （t=6.876,P〈0.05）.In addition, urinary Cystatin C （0.653±0.148）mg/L, urinary α1-microglobulin （1.53±0.56）mg/dl and urinary β2-microglobulin （0.585±0.088）mg/L in the oxalate group （t〉8.442,P〈0.05）.Conclusion There may be a correlation between renal stone composition with urine metabolic changes.