重庆市泌尿系结石患者1972例结石成分分析

Urinary stone composition analysis of 1972 cases in Chongqing

目的探讨重庆市泌尿系结石患者的结石成分特点。方法回顾性分析2017年5月—2021年7月于重庆医科大学附属第二医院行结石成分分析的1972例泌尿系结石患者的临床资料,其中男性1323例,女性649例;年龄14~92岁,平均(52.7±13.8)岁。按照地域差异分为渝中西部地区组(n=1532)和渝东南部地区组(n=440);再按照经济发展水平差异分为渝较发达地区组(n=1491)和渝欠发达地区组(n=481)。研究分析不同性别、年龄、地域、经济发展水平对患者的结石成分的影响。不同地区、性别、年龄患者的结石成分构成差异比较采用χ^(2)检验,各结石成分比例随年龄变化情况分析采用趋势χ^(2)检验。结果结石成分分析结果显示,1972例中混合成分结石占多数,为92.9%(1832/1972),其中以一水草酸钙+二水草酸钙结石最多,占40.8%(805/1972);单一成分结石中以二水草酸钙结石最多,占2.5%(50/1972)。女性患者相较男性患者碳酸磷灰石[53.6%(348/649)与43.5%(576/1323),P<0.05]、羟基磷灰石[25.1%(163/649)与17.2%(228/1323),P<0.05]及磷酸铵镁结石的比例[20.6%(134/649)与6.3%(83/1323),P<0.05]明显更高,而男性患者较女性患者草酸钙结石[91.4%(1209/1323)与80.7%(524/649),P<0.05]及尿酸结石的比例[9.4%(125/1323)与1.5%(10/649),P<0.05]明显更高。<40岁的患者较40~70岁及≥70岁的患者碳酸磷灰石[39.6%(155/391)与48.4%(673/1391)、50.5%(96/190),P<0.05]、磷酸铵镁结石[6.1%(24/391)与12.0%(167/1391)、13.7%(26/190),P<0.05]及尿酸结石[3.3%(13/391)与7.4%(103/1391)、10.0%(19/190),P<0.05]的比例明显更低;而<40岁患者草酸钙结石的比例明显更高[93.6%(366/391)与87.2%(1213/1391)、81.0%(154/190),P<0.05]。本研究中渝中西部地区与渝东南部地区、渝较发达地区与渝欠发达地区患者的结石成分比较,差异均无统计学意义(P>0.05)。结论重庆市泌尿系结石成分分布存在性别、年龄差异,但地域、经济发展水平差异不是特别明显。碳酸磷灰石、羟基磷灰石及磷酸铵镁结石多见于女性患者,而草酸钙及尿酸结石多见于男性患者;年龄<40岁的患者,主要以草酸钙结石为主;而年龄≥40岁的患者,以碳酸磷灰石、磷酸铵镁结石、尿酸结石多见。

Objective To investigate the composition characteristics of urolithiasis patients in Chongqing.Methods From May 2017 to July 2021,clinical data of 1972 urinary stone patients treated in the Second Affiliated Hospital of Chongqing Medical University was retrospectively analyzed.Among 1972 patients,there were 1323 males and 649 females,the average age was(52.7±13.8)years(aged 14-92 years).In this study,all of the patients were first divided into the central and western areas of Chongqing group(n=1532)and southeastern areas of Chongqing group(n=440)according to regional differences;then according to the difference of economic development level,all patients were divided into the more developed area of Chongqing group(n=1491)and the less developed area of Chongqing group(n=481).To study and analyze the influence of gender,age,region and economic development level on stone composition in patients.The distribution characteristics of urinary calculi constituents in different groups of region,gender and age were analyzed by Chi-square test,and analysis of the proportion of various urinary calculi with age were conducted by Cochran-Armitage trend test.Results The results of stone composition analysis showed that,among the 1972 cases,the mixed urinary stones were dominant in the urinary stones[92.9%(1832/1972)],in which,the most component was the calcium oxalate monohydrate+calcium oxalate dehydrate[40.8%(805/1972)];among the pure stones,the most component was the calcium oxalate dehydrate[2.5%(50/1972)].The proportion of carbonated apatite stones[53.6%(348/649)vs 43.5%(576/1323),P<0.05],hydroxyapatite stones[25.1%(163/649)vs 17.2%(228/1323),P<0.05]and magnesium ammonium phosphate stones[20.6%(134/649)vs 6.3%(83/1323),P<0.05]in female patients were significantly higher than those in male patients,but the proportion of calcium oxalate stones[91.4%(1209/1323)vs 80.7%(524/649),P<0.05]and uric acid stones[9.4%(125/1323)vs 1.5%(10/649),P<0.05]in male patients were significantly higher than those in female patients.Compared with patients aged 40-70 years and≥70 years,the proportion of carbonated apatite stones[39.6%(155/391)vs 48.4%(673/1391),50.5%(96/190),P<0.05],magnesium ammonium phosphate stones[6.1%(24/391)vs 12.0%(167/1391),13.7%(26/190),P<0.05]and uric acid stones[3.3%(13/391)vs 7.4%(103/1391),10.0%(19/190),P<0.05]was significantly lower for patients aged<40 years;but the proportion of calcium oxalate stones in patients aged<40 years was significantly higher[93.6%(366/391)vs 87.2%(1213/1391),81.0%(154/190),P<0.05].In this study,there were no significant difference in stone composition between the central and western areas of Chongqing and the southeastern areas of Chongqing,and between the more developed areas of Chongqing and the less developed areas of Chongqing(P>0.05).Conclusions There are gender and age differences in the distribution of urinary stone components in Chongqing,but the regional and economic development level differences are not particularly obvious.Carbonated apatite stones,hydroxyapatite stones and magnesium ammonium phosphate stones were more prevalent in females,calcium oxalate stones and uric acid stones were more common in males.Calcium oxalate stones were the most common in patients aged<40 years,carbonate apatite,magnesium ammonium phosphate and uric acid stones were more common in patients aged≥40 years.