24小时尿枸橼酸、草酸定量检测在泌尿系结石诊断中的应用

Study of 24h Urine Citrate and Oxalic Acid Quantitative Test in the Diagnosis in Urolithiasis

目的通过病例对照研究的方法,探讨24 h尿中枸橼酸、草酸的含量与泌尿系结石症的关系,为临床治疗及诊断提供一定依据。方法收集65例泌尿系结石患者及正常人的24 h尿液标本,测定其尿枸橼酸、草酸及钙的含量,对检测结果进行比较,并分析其与泌尿系结石的相关性。结果结石组患者24 h尿枸橼酸含量为224.26±147.63 mg,对照组人群为434.58±280.89mg,二者差异具有统计学意义(P<0.05);结石组24 h尿草酸含量为48.41±10.22mg,显著高于正常组32.34±5.26 mg,差异具有统计学意义(P<0.05);结石患者24h尿液中的枸橼酸/钙比值,显著低于正常人,差异具有统计学意义(P<0.05);尿草酸与尿枸橼酸水平呈负相关;总体上,尿草酸与尿钙无明显相关(P>0.05),但在一定浓度范围内,尿钙排泄水平随尿草酸浓度上升而增高。结论对泌尿系结石患者进行代谢评估时,24 h尿枸橼酸/钙比值的降低相对于尿枸橼酸降低可能临床意义更大,高草酸尿能导致尿钙排泄增加,枸椽酸钾制剂口服治疗对高草酸尿所致的尿钙增高可能有一定作用。

Objective To explore the relationship between renal calculus and 24h citrate excretion in patient urine from the investigation of etiology by a case-control study. Methods 24h urine of 65 cases of urolithiasis and 65 healthy people were collected. Citrate, oxalate and calcium levels for each subject were measured, then we analyzed pertinence of them. Results The average level of 24h citrate excretion in urine of urolithiasis patients was 224.26 ± 147.63 mg,lower than that of control group with 434.58 ± 280.89 mg (P 〈 0.05). Oxalate excretion in 24h urine of urolithiasis group was 48.41 ± 10.22 mg, while the control group was 32.34 ± 5.26 mg with significant difference(P 〈 0.05). The average level of 24h citrate/Ca2^＋ ratio was lower in urolithiasis patients than in those of healthy ones (P 〈 0.05). Overall, there was no significant correlation between oxalate and calcium excretion in 24h urine (P 〉 0.05), but urinary calcium excretion levels increased with the rise of urinary oxalate in certain concentration range. Conclusion 24h citrate/Ca^2＋ ratio is highly clinical meaningful in metabolic evaluation of urolithiasis patients, which appeared more significant than hypocitraturia. High oxalate level in urine might lead to increased hypercalcinuria. Potassium citrate oral treatment could be effective for curing hypercalcinuria caused by hyperoxaluria.