肾乳头CT影像变化与肾结石发生发展的相关性

Correlation between CT attenuation value of renal papilla and the occurrence and development of renal calculi

目的分析肾乳头尖端CT衰减值与肾结石发生发展之间的相关性。方法回顾性分析2020年8月-2022年7月于苏州大学附属第一医院接受住院治疗的草酸钙类肾结石患者100例,其中初次发作的结石患者(初发结石组)60例,结石复发的患者(复发结石组)40例,另选择同期健康检查者30例为对照组。使用平扫CT测量结石患者肾乳头尖端的CT衰减值并通过ROC曲线明确危险因素,进一步对结石患者的肾乳头尖端CT衰减值与24 h尿液代谢相关性进行分析。结果初发结石组及复发结石组[34.92(IQR:3.84)、43.00(IQR:8.74)]肾乳头CT衰减值明显高于对照组[32.58(IQR:5.21)](P<0.05)。与初发结石组相比,复发结石组24 h尿液中枸橼酸含量降低、钙含量升高(P<0.05)。枸橼酸根离子和钙离子均与肾乳头CT衰减值变化具有相关性(P<0.05)。结论肾乳头密度高的患者结石形成及复发的风险较高,肾乳头密度增加是结石产生及发展的一个预警信号,结石患者尿液中高钙和低枸橼酸对结石的发展具有一定影响,应考虑限制草酸钙结石患者钙的摄入并适当补充枸橼酸。

Objective To analyze the correlation between CT attenuation value of renal papilla and occurrence and development of renal calculi.Methods The clinical data of 100 patients with calcium oxalate stones treated during Aug.2020 and Jul.2022 were retrospectively analyzed,including 60 with primary stones,and 40 with recurrent stones.The 30 healthy volunteers were enrolled in the control group.CT attenuation value of renal papilla was measured with plain scan CT,and risk factors were identified with the receiver operating characteristic(ROC)curve.The correlation of CT attenuation value and 24 h urine metabolism was analyzed.Results The CT attenuation value of renal papilla was significantly higher in the primary group[34.92(IQR:3.84)]and recurrent group[43.00(IQR:8.74)]than in the control group[32.58(IQR:5.21)](P<0.05).Compared with the primary group,the recurrent group had decreased citric acid level but increased calcium level in 24 h urine(P<0.05).The citrate ion and calcium ion were correlated with the CT attenuation value(P<0.05).Conclusion Patients with high renal papilla density have a high risk of stone formation and recurrence.Increased renal papilla density is a warning signal for the development of stones.The high calcium and low citric acid in 24 h urine have certain effects on the occurrence and development of urolithiasis.Intake of calcium should be limited and citric acid should be supplemented in patients with calcium oxalate stones.