不同亚型草酸钙结石患者尿代谢异常的差异性分析

Differential analysis of urinary metabolic abnormalities in patients with different subtypes of calcium oxalate stones

目的探讨不同亚型草酸钙结石患者的24h尿代谢异常的差异性。方法回顾性分析2018年3月至2020年5月郑州大学第二附属医院收治的120例单纯草酸钙结石患者的临床资料。男90例(75.0%),女30例(25.0%)。年龄(49.1±13.5)岁。体质量指数(24.6±3.0)kg/m^(2)。合并糖尿病23例(19.2%),冠心病8例(7.0%),高血压病36例(30.0%),胃肠道疾病45例(37.5%)。合并低尿pH值11例(9.2%),高草酸尿54例(45.0%),高钙尿19例(15.8%),低枸橡酸尿72例(60.0%),高尿酸尿3例(2.5%),高尿酸血症18例(15.0%)。120例中,行输尿管软镜碎石术79例,经皮肾镜取石术28例,体外冲击波碎石术13例。根据术后结石成分分析将患者分为一水草酸钙结石组(COM组)和二水草酸钙结石组(COD组),比较两组的一般临床资料和24h尿代谢数据。分析两组结石成因的独立危险因素。结果本研究120例,COM组90例,COD组30例。COM组和COD组的尿草酸分别为41.3(30.1,54.2)mg和34.1(26.6,39.9)mg,差异有统计学意义(P=0.01);高草酸尿发生率分别为52.2%(47例)和23.3%(7例),差异有统计学意义(P<0.01)。COD组和COM组的尿钙分别为6.8(6.1,8.8)mmol和4.0(2.3,5.2)mmol,差异有统计学意义(P<0.01);高钙尿发生率分别为43.3%(13例)和6.7%(6例),差异有统计学意义(P<0.01)。COM组和COD组的尿磷酸分别为2063.5(1688.8,2803.2)mg和1231.7(766.7,1740.9)mg,差异有统计学意义(P<0.01)。COM组和COD组的血尿酸水平分别为(343.0±111.7)μmol/L和(297.6±77.6)μmol/L,差异有统计学意义(P<0.05)。两组的年龄、性别、体质量指数、糖尿病、冠心病、高血压病、胃肠道疾病、甲状旁腺激素、血红蛋白、血肌酐、血钾、血磷、血钙、血钠、结石负荷、结石侧别等差异均无统计学差异(P>0.05)。两组患者的尿钠、尿磷、尿镁、尿枸橡酸、尿尿酸水平比较差异无统计学意义(P>0.05)。二分类logistic回归分析结果显示,高草酸尿(0R=4.859,P<0.01)和尿磷酸水平升高(OR=1.001,P<0.01)是COM结石的独立危险因素;高钙尿是COD结石的独立危险因素(OR=27.856,P<0.01)。结论COM结石患者有较高的尿草酸和尿磷酸水平,更易出现高草酸尿;COD结石患者有较高的尿钙水平,更易出现高钙尿。

Objective To investigate the difference of 24h urinary metabolic abnormalities in patients with different subtypes of calcium oxalate stones.Methods The clinical data of 120 patients with simple calcium oxalate stones admitted to the Second Affiliated Hospital of Zhengzhou University from March 2018 to May 2020 were retrospectively analyzed.There were 90 males(75.0%)and 30 females(25.0%),with the age of(49.1±13.5)years old,and body mass index(BMI)of(24.6±3.0)kg/m^(2).There were 23 cases of diabetes mellitus(19.2%),8 cases of coronary heart disease(7.0%),36 cases of hypertension(30.0%)and 45 cases of gastrointestinal diseases(37.5%).There were 11 cases(9.2%)of low pH,54 cases(45.0%)of hyperoxaluria,19 cases(15.8%)of hypercalcemia,72 cases(60.0%)of hypocitrouria,3 cases(2.5%)of hyperuricuria,and 18 cases(15.0%)of hyperuricemia.In the 120 patients,79 underwent ureteral soft lithotripsy,28 underwent percutaneous nephrolithotomy,and 13 underwent extracorporeal shock wave lithotripsy.The patients were divided into calcium oxalate monohydrate stone group(COM group)and calcium oxalate dihydrate stone group(COD group).The general clinical data and urinary metabolic data of the two groups were compared.Independent risk factors for stone formation of the two groups were analyzed.Results There were 120 cases in this study,with 90 cases in COM group and 30 cases in COD group.Urinary oxalic acid in COM group and COD group was 41.3(30.1,54.2)mg and 34.1(26.6,39.9)mg,respectively,and the difference was statistically significant(P=0.01).The incidence of hyperoxaluria was 52.2%(47 cases)and 23.3%(7 cases),respectively,and the difference was statistically significant(P<0.01).Urinary calcium in COD group and COM group was 6.8(6.1,8.8)mmol and 4.0(2.3,5.2)mmol,respectively,and the difference was statistically significant(P<0.01).The incidence of hypercalcemia was 43.3%(13 cases)and 6.7%(6 cases),respectively,the difference was statistically significant(P<0.01).The urinary phosphate in COM group and COD group was 2063.5(1688.8,2803.2)mg and 1231.7(766.7,1740.9)mg,respectively,and the difference was statistically significant(P<0.01).The serum uric acid level in COM group and COD group was(343.0±111.7)μmol/L and(297.6±77.6)μmol/L,respectively,and the difference was statistically significant(P<0.05).There were no significant differences in term of age,gender,body mass index,diabetes mellitus,coronary heart disease,hypertension,gastrointestinal disease,parathyroid hormone(PTH),hemoglobin,serum creatinine,serum potassium,serum phosphorus,serum calcium,serum sodium,stone load and side between the two groups(P>0.05).There were no significant dfferences in urinary sodium,urinary phosphorus,urinary magnesium,urinary citric acid and urinary uric acid levels between the two groups(P>0.05).Binary Logistic regression analysis showed that hyperoxaluria was an independent risk factor for COM patients(OR=4.859,P<0.01).Increased urinary phosphoric acid level was an independent risk factor for COM patients(OR=1.001,P<0.01).Hypercalcemia was an independent risk factor for COD patients(OR=27.856,P<0.01).Conclusions COM calculus patients have higher urinary oxalic acid and urinary phosphoric acid levels,and are more likely to have hyperoxaluria.COD calculus patients have higher urinary calcium levels and are more likely to develop hypercalcemia.