尿路草酸盐结石预防的代谢评估及饮食干预(附946例报告)

Metabolic Assessment and Dietary Intervention for Prevention of Calcium Oxalate Calculus in Urinary Tract

目的:探讨尿路草酸盐结石患者的机体代谢情况及影响因素,并随访观察代谢紊乱患者进行饮食干预后泌尿系结石的发生情况。方法:分析收集的946例草酸盐结石患者,依据结石成份分析结果给予相应的饮食指导,并随机选取同时期内结石复发者72名和无结石复发者74名,回顾分析机体代谢情况。结果:946例草酸钙结石中混合性结石占71.3%,单纯草酸钙结石(包括一水草酸钙和二水草酸钙)占28.7%。同未复发组相比,复发组血压、空腹血糖、甘油三脂、总胆固醇、体重指数(BMI)等指标偏高,对有统计学意义的变量行Logistic回归分析,选入回归模型的有血压、BMI、空腹血糖、甘油三酯及总胆固醇,其OR值分别为1.54、1.32、1.17、1.47、1.13(P<0.05)。平均随访15个月(3~24个月),发现饮食指导是预防草酸盐结石复发的保护因子。结论:泌尿系结石以草酸盐结石为主,男性患者多于女性,31~70岁之间为高峰年龄。草酸钙结石与高血压、BMI、空腹血糖、甘油三酯及总胆固醇密切相关。采用针对性的饮食指导对草酸盐结石的预防有重要的作用。

Objective To investigate the body metabolism and its influencing factors of patients with calcium oxalate calculus in urinary tract and observe the occurrence of new urinary stones after adjusting the diet intervention in patients with metabolic disorders.Methods Total 946 patients with calcium oxalate calculus were analyzed by infrared spectrophotometry and the patients were given dietary instruction according to their respective calculi ingredient.Meanwhile,72 patients with recurrent stones were randomly selected,74 patients without stone recurrence were selected at the same time,and the body metabolism was investigated.Results Among the 946 cases of calcium oxalate calculus,calculi with mixed components accounted for 71.3%.Single component accounted for 28.7%(calcium oxalate monohydrate and calcium oxalate dehydrate).Compared with the unrelapse group,the relapse group was higher in blood pressure,fasting blood glucose,triglyceride,total cholesterol and body mass index(BMI).Logistic regression analysis was carried out on blood pressure,BMI,fasting blood glucose,triglyceride and total cholesterol,and the OR values were 1.54,1.32,1.17,1.47 and 1.13,respectively(P<0.05).The average follow up period of patient was 11 months(3–24months).Dietary guidance was the protective factor in prevention of the recurrence of oxalate stones.Conclusion Oxalate stones are the main stones in urinary calculi,male patients are more than female,31–70 years old is the peak age.Hypertension,fasting blood glucose,triglyceride,total cholesterol and BMI were correlated closely with calcium oxalate calculus.The pertinent dietary instruction has important clinical significance for the prevention of calcium oxalate calculus.