赣南地区上尿路结石患者生化指标特点分析及与上海地区对比研究

Characteristic analysis of biochemical indexes in patients with upper urinary tract calculi in southern Jiangxi and comparative study with characteristics in Shanghai area

目的探讨兴国县上尿路结石患者生化指标特点,并与上海地区上尿路结石患者对比相应指标差异。方法回顾性分析2018年1月—2019年2月兴国县人民医院301名(兴国组)及2011年4月—2015年10月上海市华山医院661例(上海组)上尿路结石患者的基础信息、临床参数、生化指标与结石特点,并对比研究两组结石患者的血尿生化指标差异。结果兴国组结石负荷明显高于上海组,兴国组女性结石患者近50%;兴国组绝大多数患者就诊时为铸型结石(85.7%),而中重度积水患者达33.6%,除了14例信息缺失,其余患者均合并尿路感染;单因素分析显示糖尿病与复发性结石显著相关(P<0.001),单侧肾脏中单发结石较多发结石更易导致重度积水(P=0.04);铸型结石患者血肌酐水平显著低于非铸型结石患者(P=0.028),而其血白蛋白水平显著高于非铸型结石患者(P=0.047)。单因素分析并多因素分析校正后发现,兴国组上尿路结石患者相较上海组具有以下统计学显著特征:女性患者比例高(P<0.001)、血肌酐水平明显高(P=0.013)、总蛋白显著低(P=0.021),血钠(P=0.03)、血钾(P<0.001)显著高,而尿pH值显著低(P<0.001)。结论兴国县上尿路结石患者结石负荷及复杂程度高于上海地区,而其多项生化指标与上海地区患者相比存在显著差异,这可能源于饮食习惯差别,该研究对兴国县结石患者饮食指导具有重要意义。

Objective To explore the characteristics of biochemical indexes of patients with upper urinary tract calculi in Xingguo County,and to compare the differences of corresponding indexes with patients with upper urinary tract calculi in Shanghai.Methods The basic information,clinical parameters,biochemical indicators and stone characteristics of 301 patients with upper urinary tract calculi who were admitted to Xingguo people's hospital from January 2018 to February 2019(Xingguo group)and 661 patients with upper urinary tract calculi who were admitted to Shanghai Huashan hospital from April 2011 to October 2015(Shanghai group)were retrospectively analyzed.The differences in blood and urine biochemical indexes between the two groups were compared.Results The stone burden of Xingguo group was significantly higher than that of Shanghai group.Female patients accounting for nearly 50%of the Xingguo group.Most of the patients in the Xingguo group were diagnosed as cast mould stone at admission(85.7%),and 33.6%of the patients with moderate to severe hydronephrosis.All the patients were complicated with urinary tract infection except 14 cases with missing information.Univariate analysis showed that diabetes was significantly associated with recurrent stones(P<0.001).Single stone was more likely to lead to severe hydronephrosis than multiple stones in unilateral kidney(P=0.04).The serum creatinine level of patients with cast mouldstones was significantly lower than that of patients with non-cast mouldstones(P=0.028),while the serum albumin level was significantly higher than that of patients with non-cast mouldstones(P=0.047).Univariate analysis and multivariate analysis after adjustment showed that the Xingguo group had the following statistically significant characteristics compared with the Shanghai group:a higher proportion of female patients(P<0.001),higher serum creatinine level(P=0.013),lower total protein level(P=0.021),serum sodium(P=0.03),and serum potassium(P<0.001)and lower urine pH(P<0.001).Conclusions The stone burden and complexity of patients with upper urinary tract calculi in Xingguo county are higher than those in Shanghai,and many biochemical indexes are significantly different from those in Shanghai,which may be due to the difference in dietary habits.This study has important significance for the diet guidance of patients with upper urinary tract calculi in Xingguo county.