泌尿系结石成分与代谢异常的临床研究

Clinical study for compostion of urinary calculi and metabolic abnormality

目的探讨泌尿系结石患者的结石成分与代谢异常的关系。方法选择2012年6月至2016年10月在佛山市南海区第二人民医院泌尿外科确诊为泌尿系结石的200例患者的临床资料,200例患者入选并参加该研究,平均年龄(36.2±3.4)岁,男女比例2:1。收集泌尿系结石患者的结石标本和血清及尿液样本,测定结石成分和血/尿代谢情况,具体测定指标为pH值、肌酐、尿酸、钙离子、磷酸盐、草酸盐、枸橼酸盐和镁离子浓度等。结果有86(43%)例患者结石成分分析为草酸钙结石;90.5%患者存在代谢异常,最常见是高草酸尿症(64.5%),其次是高钙尿症,高钙血症,低枸橼酸尿症和高尿酸血症。高草酸尿症易发草酸钙结石、草酸钙/磷酸钙及草酸钙/尿酸混合成分结石;低枸橼酸尿症易发草酸钙、磷酸钙结石;高钠血症及高尿酸血症都易发草酸钙结石;高胱氨酸血症易发胱氨酸结石。结论代谢异常在泌尿系结石患者中常见,大多数为高草酸尿症、高钙尿症、高钙血症、低枸橼酸尿症、高尿酸血症。代谢异常容易诱发结石,结石成分和代谢异常分析有助于选择合适的医学治疗和调整饮食习惯来预防结石复发。

Objective To explore the relationship between calculus composition and metabolic abnormality in patients with urinary calculi. Methods 200 cases of urinary calculi were collected with samples of calculi, serum and urine samples, the composition of calculus and blood/ttrine metabolism were measured. Results 86 03%） of the patients were analyzed with calculus of calcium oxalate. Metabolic abnormalities were found in 90.5% of the patients, most frequently with hyperoxalic acid （64.5%）, followed by hypercalciuria, hypercalcemia, hypocitric acid and hyperuricemia. High oxalic acid urine induced calcium oxalate stone, the mixed composition stone of calcium oxalate/calcium phosphate and calcium oxalate/ uric acid ;low citric acid urine induced calcium oxalate and calcium phosphate stones; Hypernatremia and hyperuricemia are all induce calcium oxalate calculi; Homocysteine only induced cysteine calculi. Conclusions Metabolic abnormalities are common in patients with urinary calculus, most of which are high oxalate, hypercalciuria, hypercalcemia, low citrate, hyperuricemia. Metabolic abnormalities can induce calculi, calculus composition and metabolic analysis can help to choose appropriate medical treatment and adjust dietary habits which can prevent the recurrence of stones.