开封市及周边地区成人尿石症成分分析及防治策略研究

Components of adult urolithiasis in Kaifeng City and surrounding areas and the prevention strategies

目的探讨开封市及周边地区成人尿石症(USD)的成分及防治策略。方法选择2017年1月至2019年12月开封市人民医院收治的开封市及周边地区200例成人泌尿系结石患者,结石标本由手术取出、体外冲击波碎石后排出或药物排出,对收集的200份结石标本进行红外光谱法定性分析。结果开封市及周边地区USD患者结石成分以草酸钙为主,共151例,占比75.50%;其中单纯草酸钙65例,占比32.50%;混合性结石87例,占比43.50%,其中以一水草酸钙+二水草酸钙、一水草酸钙+无水尿酸、一水草酸钙+碳酸磷灰石多见,分别占比15.00%、13.50%、12.00%。男性患者无水尿酸、碳酸磷灰石分别占比18.03%、5.74%,女性则依次为5.13%、17.95%,男性患者无水尿酸结石占比显著高于女性(P<0.05),而碳酸磷灰石结石占比显著低于女性(P<0.05)。18~44岁者一水草酸钙结石占比41.03%,显著高于45~59岁和≥60岁的年龄段者(24.32%、16.67%,P<0.05);18~44岁者一水草酸钙+二水草酸钙结石占比20.51%,显著高于≥60岁的年龄段者(6.25%,P<0.05);≥60岁者无水尿酸结石占比31.25%,均显著高于18~44岁和45~59岁的年龄段者(6.41%、8.11%,P<0.05)。上尿路结石成分中一水草酸钙、一水草酸钙+二水草酸钙占比(31.95%、17.75%)均显著高于下尿路结石(12.90%、0%,P<0.05),而下尿路结石成分中无水尿酸、碳酸磷灰石占比(35.48%、25.81%)均显著高于上尿路结石(8.88%、7.69%,P<0.05)。结论开封市及周边地区成人USD的成分以草酸钙为主,且结石成分与性别、年龄、发病部位均有一定的相关性;此外结石发生的部位多见于上尿路,男性多于女性。饮食干预、适当运动、针对性药物干预有助于防治USD的发生及复发。

Objective To explore the components of adult urolithiasis(USD)in Kaifeng City and surrounding areas,and the prevention strategies.Methods From January 2017 to December 2019,200 adult USD patients in Kaifeng and its surrounding areas treated in Kaifeng People's Hospital were enrolled.Stone specimens were removed by surgery,extracorporeal shock wave lithotripsis or drug expulsion.Qualitative analysis of 200 collected stone specimens was performed by infrared spectroscopy.Results There were 151 cases(75.50%)of patients with USD in Kaifeng city and surrounding areas with calcium oxalate as the main stone component.Among them,a simple component of calcium oxalate,and mixed components of stones were detected in 65(32.50%)cases and 87(43.50%)cases,respectively.In detail,the mixed components of stones were mainly calcium oxalate monohydrate+calcium oxalate dehydrate,calcium oxalate monohydrate+anhydrous uric acid,and calcium oxalate monohydrate+carbonate apatite,accounting for 15.00%,13.50%,and 12.00%,respectively.The main component of stone specimens with anhydrous uric acid and carbonate apatite accounted for 18.03%and 5.74%in male patients,which were 5.13%and 17.95%in female patients,respectively.The proportion of anhydrous uric acid stones in male patients was significantly higher than that in female patients(P<0.05),while that of carbonate apatite stones was significantly lower than that in female patients(P<0.05).The proportion of patients with the stones consisted of calcium oxalate monohydrate in 18-44 years group was significantly higher than that in 45-59 years group and≥60 years group(41.03%VS 24.32%VS 16.67%,P<0.05).The proportion of patients with the stones consisted of calcium oxalate monohydrate+calcium oxalate dihydrate was significantly higher in 18-44 years group than that in≥60 years group(20.51%VS 6.25%,P<0.05).The proportion of patients with the stones consisted of anhydrous uric acid in≥60 years group was significantly higher than that in 18-44 years group and 45-59 years group(31.25%VS 6.41%VS 8.11%,P<0.05).The proportion of calcium oxalate monohydrate,and calcium oxalate monohydrate+calcium oxalate dihydrate in the composition of upper urinary tract stones was significantly higher than that of lower urinary tract stones(31.95%,17.75%VS 12.90%,0%,P<0.05).However,the proportions of lower urinary tract stones of anhydrous uric acid and carbonate apatite were significantly higher than those of upper urinary tract stones(35.48%,25.81%VS 8.88%,7.69%,P<0.05).Conclusion Stones in adult USD patients in Kaifeng City and its surrounding areas are mainly composed of calcium oxalate.The component of stones has a certain correlation with sex,age and site of the disease.In addition,calculi in the upper urinary tract more frequently affect males than females.Dietary intervention,appropriate exercise and targeted drug intervention are helpful to the prevention and treatment of USD and its recurrence.