儿童泌尿系统结石临床特点的meta分析

Meta analysis of clinical characteristics of urinary calculi in children

目的 调查儿童泌尿系统结石形成的临床特点和最重要的危险因素。方法 通过Cochrane图书馆、Pub Med、Pro Quest、ELEVIER Science Direct、Embase、Springerlink、中国知网全文数据库(CNKI)和万方数据库,检索从2003年1月至2018年9月之间关于儿童泌尿系统结石临床特点分析的文献,利用STATA 14. 0进行统计分析。结果 儿童泌尿系统结石男性比例为62. 1%[95%CI(57. 2%,67. 1%)]。39. 4%[95%CI(26. 5%,52. 2%)]的儿童尿石症患者存在结石阳性家族史,25. 3%[95%CI(19. 2%,31. 3%)]存在泌尿系统感染史,16. 6%[95%CI(12. 3%,20. 9%)]存在泌尿系统解剖异常。儿童泌尿系统结石最常见于肾[63. 6%,95%CI(49. 9%,77. 3%)],其次为输尿管[17. 2%,95%CI(13. 4%,21. 0%)]、膀胱[12. 4%,95%CI(6. 9%,18. 7%)]。儿童泌尿系统结石中单一成分占58. 8%[95%CI (48. 7%,68. 9%)],最常见的成分为草酸钙[49. 4%,95%CI(36. 7%,62. 1%)],其次为尿酸[7. 9%,95%CI(4. 1%,11. 6%)]。最常见的尿代谢异常为高钠尿症[38. 8%,95%CI(27. 9%,49. 7%)],其次是高钙尿症[33. 4%,95%CI(27. 3%,39. 4%)]。结论遗传代谢异常、泌尿系统感染、解剖结构异常等因素是儿童泌尿系统结石发病的高危因素,只有纠正调节代谢紊乱,妥善处理尿路感染,矫正解剖异常,才能减少和防止尿路结石的复发。

Objective We investigated the clinical characteristics and the most important risk factors of urinary calculi in children.Methods Using Cochrane Library,PubMed,ProQuest,ELEVIER Science Direct,Embase,Springerlink,China National Knowledge Infrastructure(CNKI),and Wanfang database,we reviewed literature on clinical characteristics of urinary calculi in children from January 2003 to September 2018,and data was analyzed using STATA 14.0.Results Incidence of calculi in male children was 62.1%[95%CI(57.2%,67.1%)].39.4%[95%CI(26.5%,52.2%)]children with urolithiasis had a family history of positive stones,25.3%[95%CI(19.2%,31.3%)]had a history of urinary infection,and 16.6%[95%CI(12.3%,20.9%)]had abnormal urinary anatomy.In addition,urinary calculi were most commonly found in the kidney[63.6%,95%CI(49.9%,77.3%)],followed by ureter[17.2%,95%CI(13.4%,21.0%)],and bladder[12.4%,95%CI(6.9%,18.7%)].The single component of urinary calculi in children accounted for 58.8%[95%CI(48.7%,68.9%)],the most common component was calcium oxalate[49.4%,95%CI(36.7%,62.1%)],followed by uric acid[7.9%,95%CI(4.1%,11.6%)].The most common urinary metabolic disorders were hypernatremia[38.8%,95%CI(27.9%,49.7%)],followed by hypercalciuria[33.4%,95%CI(27.3%,39.4%)].Conclusions Heredity metabolic abnormalities,urinary tract infection,and anatomical structural abnormalities are important risk factors of urinary calculi in children.Stone recurrence could be reduced and prevented by regulating metabolic disorders,managing urinary tract infection,and correcting anatomical abnormality.