磷酸镁铵结石、碳酸磷灰石与草酸钙结石易感因素回顾性分析研究

Retrospective analysis of susceptibility factors of magnesium ammonium phosphate stone, carbonate apatite and calcium oxalate stone

目的探讨感染性结石与草酸钙结石人群临床特点及差异性,为临床工作中筛选感染性结石提供参考。方法根据四川大学华西医院2014年6月—2017年4月碎石中心结石成分分析结果,选取感染性结石患者392例(分为A、B两组,其中A组为磷酸镁铵结石患者56例,B组为碳酸磷灰石患者336例)及草酸钙结石患者392例(C组),回顾性分析并比较其临床资料。结果 A组女性占比(75.0%)、结石长径[(3.9±2.5) cm]、铸型结石发生率(41.1%)大于B组[39.3%、(2.4±1.3)cm、6.0%],且两组患者女性占比、结石长径大于C组[30.1%、(1.9±0.7)cm],差异有统计学意义(P<0.05)。在既往手术史及尿路复杂因素如输尿管狭窄等方面,3组间差异无统计学意义(P>0.05);感染性结石患者糖尿病、肾小管酸中毒、高脂血症患病率高于C组,且A组患者肾小管酸中毒、高脂血症患病率(16.1%、39.3%)高于B组(0.6%、21.1%);A组尿培养阳性率(58.9%)高于B组(20.5%),且A、B组均高于C组(8.9%),差异有统计学意义(P<0.017)。A组尿培养以奇异变形杆菌、大肠埃希菌为主,B组及C组以大肠埃希菌为主。结论大体积结石合并糖尿病、肾小管酸中毒、高脂血症,同时尿培养阳性的患者,患感染性结石的可能性较高。

Objective To investigate the differences in characteristics and susceptibility factors between infectious stones and calcium oxalate stones, and provide reference value for screening infectious stones in clinical work. Methods According to the results of analysis of stone components in the extracorporeal shock wave lithotripsy center of West China Hospital of Sichuan University between June 2014 and April 2017, 392 patients with infectious stones （including 56 patients with magnesium ammonium phosphate stones in group A and 336 patients with calcium carbonate apatite in group B） and 392 patients with calcium oxalate stone （group C） were selected to discuss the difference of clinical features by retrospectively analyzing the clinical data. Results The proportion of females, the long diameter of stones and the proportion of staghorn stones in group A [75.0%, （3.9±2.5） cm, 41.1%] were higher than those in group B [39.3%, （2.4±1.3） cm, 6.0%], and the proportion of females and the long diameter of stones in group A and B were larger than those in group C [30.1%, （1.9±0.7） cm]; the differences above were statistically significant （P〈0.05）. There was no significant difference among the three groups in surgically history or complicated factors of urinary tract such as ureteral stricture （P〉0.05）. The prevalences of diabetes, renal tubular acidosis and hyperlipidemia in patients with infectious stones were higher than those in group C. The prevalences of renal tubular acidosis and hyperlipidemia in group A （16.1%, 39.3%） were higher than those in group B （0.6%, 21.1%）, the positive rate of urine culture in group A （58.9%） was higher than that in group B （20.5%）, which were both higher than that in group C （8.9%）; these differences were statistically significant （P〈0.017）. The bacteria cultured from urine were mainlyProteus mirabilis and Escherichia coli in group A, and Escherichia coli in group B and group C. Conclusion Patients with large volume of stones, complicated with diabetes, renal tubular acidosis, hyperlipidemia and positive urine culture are more likely to have infectious stones.