上尿路非尿酸结石成分分析及其与血尿酸相关性

Component analysis of non-uric acid calculus in upper urinary tract and its correlation with serum uric acid

目的回顾性分析上海崇明地区上尿路结石成分,探索其与血尿酸水平相关性,为早期预防和合理治疗提供科学参考依据。方法收集上海交通大学医学院附属新华医院崇明分院泌尿外科2017年1月至2018年6月进行输尿管(软)镜碎石取石术、经皮肾镜碎石取石术150例上尿路结石标本,采用红外光谱分析法定性分析结石成分,试剂法检测血尿酸水平。结果 150例标本中,单纯性结石77例,混合性结石73例。结石成分含草酸钙109例,磷酸镁铵83例,碳酸磷灰石45例,尿酸结石17例,胱氨酸结石6例。血尿酸增高者121例。按结石成分血尿酸增高率:尿酸结石(100.00%)>含草酸钙(81.65%)>含磷酸镁铵(72.29%)>含碳酸磷灰石(53.33%)>胱氨酸结石(50.00%)。含碳酸磷灰石患者与含磷酸镁铵、含草酸钙、尿酸结石患者血尿酸增高率比较差异有统计学意义(P<0.05),含磷酸镁铵患者与尿酸结石患者血尿酸增高率比较差异有统计学意义(P<0.05)。降酸治疗组结石复发率及残余结石排除率略高于常规随访组,但差异均无统计学意义(P>0.05)。结论上尿路非尿酸结石与血尿酸增高具有相关性,改变体内高尿酸状态可能有助于控制上尿路结石的发生及进展。

Objective By a retrospective analysis of upper urinary tract stone composition,to explore its correlation with blood uric acid levels and provide scientific basis for early prevention and reasonable treatment.Methods A total of 150 urinary stone samples were collected by ureteroscopic(soft)lithotripsy and percutaneous nephrolithotripsy performed in urology department of Chongming Branch of Xinhua Hospital Affiliated to Shanghai Jiaotong University Medical College from January 2017 to June 2018.Qualitative analysis of stone composition was made by infrared spectrum,and the level of blood uric acid was determined by reagent method.Results Of 150 specimens,77 were simple stones and 73 were mixed stones.In stone composition,there were 109 calcium oxalate stones,83 ammonium phosphate stones,45 carbonate apatite,17 uric acid stones and 6 cysteine stones.The level of blood uric acid elevated in 121 cases.The increased rate of blood uric acid changed with different stone components:uric acid stone(100.00%),calcium oxalate(81.65%),magnesium ammonium phosphate(72.29%),carbonate apatite(53.33%),cystine stone(50.00%).There were significant differences between the patients with stone of carbonate apatite and those with stones of magnesium ammonium phosphate,calcium oxalate and uric acid stones(P<0.05)and between the patients with stone of magnesium ammonium phosphate and those with uric acid stone(P<0.05).The recurrence rate and the residual stone removal rate in the patients with acid-reducing therapy were slightly higher than those with routine follow-up visit,but there was no statistical difference.Conclusion Non uric acid calculus is related to the elevation of blood uric acid level,and changing the state of high uric acid level may help to control the occurrence and progress of urinary stones in upper urinary tract.