新疆地区61例儿童尿酸铵结石单中心临床研究

A single-center clinical study of 61 children with ammonium urate stones

目的分析新疆地区儿童尿酸铵结石的临床特点,为儿童尿酸铵结石的防治提供临床参考。方法回顾性分析2016—2021年于新疆维吾尔自治区人民医院收住入院的所有尿酸铵结石患儿的临床资料,包括患儿的一般情况、结石相关参数、随机尿pH值、尿培养、生化检查结果,并比较纯尿酸铵结石与混合尿酸铵结石患儿的血清总蛋白、白蛋白、钠、钾、钙、镁、尿酸水平及尿pH值。结果61例(31.6%)儿童患有尿酸铵结石,平均年龄(4.05±3.37)岁,男女比例为2.21∶1。其中肾脏结石37例(60.7%),上尿路结石50例(82.0%)。混合型尿酸铵结石中最常见的混合成分是草酸钙,其中以一水草酸钙、一水草酸钙和二水草酸钙混合物较为常见。与混合型尿酸铵结石患儿相比,纯尿酸铵结石患儿年龄较小(P=0.001),结石最大径较小(P=0.003)。14例患儿(23.0%)尿培养阳性,其中大肠埃希菌7例(50%),非解脲酶细菌11例(78.6%)。结论儿童尿酸铵结石的致病菌主要为非解脲酶细菌,男孩发病率较高,好发于上尿路,草酸钙为最常见的混合结石成分。纯尿酸铵结石患儿较混合型结石患儿的年龄、结石最大径更小。

Objective To analyze the clinical characteristics of children with ammonium urate stones in Xinjiang,so as to provide reference for the prevention and treatment of this disease.Methods The clinical data of all children with ammonium urate stones admitted to the People's Hospital of Xinjiang Uygur Autonomous Region from 2016 to 2021 were retrospectively analyzed,including age,sex,body mass index,stone site,stone size,stone component,urine pH,urine culture and biochemical examination results.The serum total protein,albumin,sodium,potassium,calcium,magnesium,uric acid and urine pH were compared between the pure and mixed groups.Results A total of 61 children(31.6%)had ammonium urate stones,their average age was(4.05±3.37)years,and the male to female ratio was 2.21∶1.Among them,there were 37 cases(60.7%)of renal calculi and 50 cases(82.0%)of upper urinary calculi.The most common component of mixed ammonium urate stones was calcium oxalate,including calcium oxalate monohydrate,calcium oxalate monohydrate and calcium oxalate dihydrate.Compared with mixed type,children with pure stone type had a younger age(P=0.001)and a smaller stone size(P=0.003).Positive urine culture was detected in 14 cases(23.0%),7 of which(50%)were infected with Escherichia coli,and 11(78.6%)with non-urease bacteria.Conclusion Non-urease bacteria are the main pathogens of urinary tract infection in children with ammonium urate stones.The incidence is higher in boys,and the most common stone location is upper urinary tract.Calcium oxalate is the most common mixed component.Pure type is more common in young children and the stones are relatively small.