肾结石患者的代谢评估在饮食防治中的临床研究

Clinical study of metabolic assessment in patients with renal calculi in diet prevention and treatment

目的 对肾结石患者进行代谢评估,探讨和研究通过饮食干预来预防和治疗肾结石形成和复发,为临床提供依据。方法 收集2016年10月至2017年10月,本院实施微创取石手术的163例患者收集其结石标本进行结石成分分析和留取尿液行24 h尿液成石危险因素进行检测,随机分为对照组81例和实验组82例。对照组多饮水,不行特殊饮食预防;实验组根据结石成分及24 h尿成石危险因素的结果给予相应的饮食预防,两组患者均随访半年,观察两组患者预防后对肾结石复发率的影响。结果 163例肾结石患者中157例完成研究(对照组79例,实验组78例),研究脱落率3.68%(6/163)。对照组预防前后24 h尿液成分分析变化比较,差异无统计学意义(P>0.05);实验组饮食预防前后比较,尿草酸、尿酸、尿钙指标降低,尿枸橼酸指标含量升高,差异均有统计学意义(均P<0.05),尿磷、尿镁指标在预防前后比较,差异无统计学意义(P>0.05)。饮食预防6个月后,对照组出现5例肾结石复发,复发率6.33%(5/79);实验组78例中无复发病例,复发率显著低于对照组,差异有统计学意义(P<0.01)。结论 代谢评估可以发现影响肾结石发生、复发的潜在危险因素,而代谢评估的结果可以制定个性化的预防措施,可有效降低肾结石的复发,值得在临床推广应用。

Objective By analyzing the metabolic assessment of patients with renal calculi,to explore and study the prevention and treatment of rental calculi formation and recurrence through dietary intervention,to provide evidence for clinical practice.Methods 163 patients undergoing minimally invasive lithotomy were collected from October 2016 to October 2017,then the stone specimens were collected and analyzed,and the urine samples were taken to detect the risk factors of 24 h urinary stone formation.They were randomly divided into control group(81 cases)and experimental group(82 cases).The control group had more drinking water without special diet prevention,while the experimental group was given corresponding diet prevention according to the result of the stone composition and the risk factors of 24 h urinary stone formation.The two groups were followed up for six months,to observe the effects on the recurrence rate of renal calculi.Results Among 163 patients with renal calculi,157 cases completed the study(79 cases in the control group and 78 cases in the experimental group),the shedding rate was 3.68%(6/163).In the control group,there was no statistically significant difference in the analysis of 24 h urine composition before and after prevention(P>0.05);the indexes of urine oxalic acid,uric acid,and urine calcium decreased and the index of urine citric acid increased in the experimental group after prevention,with statistically significant differences(P<0.05),the indexes of urine phosphorus and urine magnesium did not change significantly(P>0.05).After 6 months of diet prevention,5 cases of renal calculi recurred in the control group,and the recurrence rate was 6.33%(5/79);there was no recurrence in 78 cases of the experimental group;the recurrence rate of the experimental group was significantly lower than that of the control group,with statistically significant difference(P<0.01).Conclusions Metabolic assessment can detect the potential risk factors that affect the occurrence and recurrence of renal calculi,and individualized preventive measures can be made according to the results of metabolic assessment,which can effectively reduce the recurrence of renal calculi,worthy of clinical application.