泌尿系结石患者24小时尿液代谢分析

Analysis of 24h urine metabolism in patients with urolithiasis

目的研究泌尿系结石患者的尿液代谢异常类型,为结石患者进一步的病因治疗提供参考。方法选取2018年6月~2019年6月于我院泌尿外科就诊的泌尿系结石住院患者838例,根据患者有无randall斑分为randall斑组与无randall斑组,其中无randall斑组542例,randall斑组患者296例,并对所有入组患者行24h尿液代谢分析,检测24h尿中钠盐、钙盐、磷盐、镁盐、尿酸、枸橼酸盐及草酸盐的含量。结果两组患者低枸橼酸尿症、高草酸尿症、低镁尿症、高钠尿症及高尿酸尿症发病率无明显差异,而randall斑组高磷尿症与高钙尿症发病率高于无randall斑组,差异具有统计学意义(P<0.05)。两组患者最常见的单一代谢异常均为低枸橼酸尿,两种混合尿液代谢异常患者336例,其中最常见的混合类型为低镁尿合并低枸橼酸尿症、高草酸合并低枸橼酸尿症;3种及以上混合尿液代谢异常患者104例,其中最常见为低镁尿症+低枸橼酸尿症+高草酸尿症混合代谢异常。男性患者低枸橼酸尿症、高草酸尿症发病率高于女性患者,差异有统计学意义(P<0.05)。结论泌尿系结石患者24h尿液中枸橼酸盐、镁盐和草酸盐含量异常是结石生成和发展最常见的代谢原因,男性患者较女性患者更易发生低枸橼酸、高草酸代谢异常;相较于无randall斑结石患者来说,randall斑患者更易伴发高磷、高钙代谢异常,通过24h尿液分析可明确结石患者成石的代谢因素,对预防结石的形成和复发具有重要意义。

Objective To study the types of abnormal urinary metabolism in patients with urolithiasis and to provide guidance for further etiological treatment of urolithiasis. Methods 838 patients with urolithiasis admitted to the Department of Urology in our hospital from Jun 2018 to Jun 2019 were divided into randall plaque group and no randall plaque group, according to whether the patient had randall plaque. There were 542 cases in randall plaque group and 296 cases in no randall plaque group. All patients were enrolled in the 24-hour urine metabolism analysis, and the content of 24-hour urine sodium, calcium, phosphorus, magnesium, uric acid, citrate and oxalate were recorded. Results There was no significant difference in the incidence of hyponatronemia, hyperoxaluria hypomagnesemia, hypernattouria and hyperuricemia between the two groups, but the incidence of hyperphosphatemia and hypercalciuria in the randall plaque group were higher than that in the no randall plaque group, the difference was statistically significant (P< 0.05). The most common single metabolic abnormalities in both groups were hypocitricuria. There were 336 patients with two abnormalities in urine metabolism, the most common type were hypomagnesemia+hypocitricuria and hyperoxaluria+hypocitricuria. A total of 104 patients with three kinds of mixed urinary metabolic abnormalities, the most common type was hypomagnesemia+hypocitricuria+hyperoxaluria. The incidence of hyponatronemia and hyperoxaluria in male patients were higher than female patients, the difference was statistically significant (P< 0.05). Conclusion The most common risk factors of stone in 24h urine of patients with urolithiasis are abnormalities in magnesium, citrate and oxalate. Male patients are more prone to have low citrate and high oxalate than female patients. Compared with patients without randall plaque, patients with randall plaque are more likely to have abnormal metabolism of phosphorus and calcium, 24h urine analysis can clarify the metabolic factors of stone formation in patients with urolithiasis, which is of great significance to prevent the formation and recurrence of urolithiasis.