单中心592例儿童泌尿系结石成分分析

Analysis of children urinary stone composition in 592 cases in a single-center

目的探讨儿童泌尿系结石成分特点及其在不同性别和年龄组间的分布差异。方法回顾性分析2015年10月至2019年10月湖南省儿童医院行结石成分分析的592例泌尿系结石患儿的临床资料。男430例,女162例;中位年龄4.0(0.3~18.0)岁。592例中,457例为上尿路结石(其中424例为单侧,33例为双侧),124例为下尿路结石,11例为上尿路合并下尿路结石。泌尿系结石标本获得方式为经皮肾镜取石术、输尿管镜取石术、开放手术或患儿自行排出。对于多发结石患儿,取不同位置结石进行分析。共获取643例次结石样本,其中结石位于肾313例次,输尿管194例次,膀胱89例次,经尿道自行排出47例次。分析结石成分及其在不同性别和年龄的分布差异。结果592例(共643例次)中,单一成分结石419例次(65.2%),混合成分结石224例次(34.8%)。主要结石成分为草酸钙361例次(56.1%)、尿酸氢铵130例次(20.0%)、胱氨酸56例次(8.7%)、磷酸钙33例次(5.1%)、尿酸类33例次(5.1%)、磷酸铵镁25例次(3.9%)和黄嘌呤5例次(0.8%)。女性较男性草酸钙结石的比例高[65.6%(118/180)与52.5%(243/463),P<0.05]。女性上尿路结石占比高于男性[93.4%(168/180)与73.2%(339/463),P<0.05]。不同年龄组中草酸钙、尿酸氢铵、胱氨酸、磷酸铵镁结石构成比差异有统计学意义(P<0.05),草酸钙结石在6~10岁占比最高(35.6%),尿酸氢铵和胱氨酸结石在1~2岁占比最高(分别为45.4%和42.9%),磷酸铵镁结石在3~5岁、6~10岁及11~18岁的占比均为24%。结论儿童泌尿系结石主要成分以草酸钙为主,其次是尿酸氢铵和胱氨酸。年龄和性别与结石成分的分布相关,草酸钙结石常见于女性及6~10岁儿童,尿酸氢铵和胱氨酸结石常见于1~2岁儿童,磷酸铵镁结石在3~5岁、6~10岁及11~18岁儿童中均较常见。

Objective To investigate the characteristics of urinary stones composition in children and the differences in their distribution among dfferent sexes and age groups.MethodsThe clinical data of 592 children with urinary stones who underwent stone composition analysis using infrared spectroscopy at Hunan Children's Hospital from October 2015 to October 2019 were retrospectively analyzed.There were 430 males and 162 females.The median age was 4.0(0.3 to 18.0)years old.The stone composition and the differences in its distribution in different sex and age groups were analyzed.ResultsA total of 643 urinary stones were analyzed in 592 cases,with 419(65.2%)single-component stones and 224(34.8%)mixed-component stones.The main stone components were calcium oxalate in 361 cases(56.1%),ammonium hydrogen urate in 130 cases(20.0%),cystine in56cases(8.7%),calcium phosphate in 33cases(5.1%),uric acids in 33cases(5.1%),magnesium ammonium phosphate in 25cases(3.9%),and xanthine in 5 cases(0.8%).The percentage of calcium oxalate stones was higher in women than in men[65.6%(118/180)vs.52.5%(243/463),P<0.05].The proportion of upper urinary tract stones was higher in girl than in boy[93.4%(168/180)vs.73.2%(339/463),P<0.05].The differences in the composition ratios of calcium oxalate stones,ammonium hydrogen urate,cystine,and magnesium ammonium phosphate stones in different age groups were statistically significant(P<0.05),with the highest proportion of calcium oxalate stones(35.6%)at 6 to 10 years of age,ammonium hydrogen urate and cystine stones at 1 to 2 years of age(45.4%and 42.9%),and magnesium ammonium phosphate stones at 3 to 5,6 to 10,and 1l to 18 years of age,the percentage of urinary stones in children was 24%.Conclusions The main component of urinary stones in children is calcium oxalate,followed by ammonium hydrogen urate and cystine.Age and gender correlate with the distribution of stone components.Calcium oxalate stones are common in females and in children aged 6 to 10 years,ammonium hydrogen urate and cystine stones are common in children aged 1 to 2 years,and magnesium ammonium phosphate stones are more common in children aged 3 to 5 years,6 to 10 years,and 11 to 18years.