闽西南地区861例泌尿系结石患者的结石成分分析

目的：分析闽西南地区泌尿系结石患者的结石成分。方法收集861例泌尿系结石患者的结石标本,进行红外光谱分析测定,比较不同性别、年龄、结石部位的泌尿系结石的化学成分特征。结果30～60岁组泌尿系结石发病率达高峰,男性多于女性,上尿路结石明显多于下尿路结石（ P均＜0．05）。单纯性结石占40．64％,混合性结石占59．36％。结石成分以草酸钙最高（89．99％）,其次为碳酸磷灰石（56．66％）,无水尿酸或尿酸铵、六水磷酸镁铵、二水磷酸氢铵钙、L-胱氨酸等成分较少。男性和女性无水尿酸/尿酸铵结石的检出率分别为11．58％、5．84％,六水磷酸镁铵结石的检出率分别为6．13％、12．41％（P均＜0．05）。结论闽西南地区泌尿系结石化学成分以草酸钙为主,性别对结石成分有影响。     

吉林省老年肾结石患者结石成分分析

目的初步探讨吉林省老年肾结石患者结石成分及结石分析的临床意义。方法选取该院2008年9月至2011年5月因肾铸形结石行经皮肾镜钬激光碎石术治疗的105例患者作为研究对象。其中男78例,女27例,年龄50～68岁,男性平均年龄(57.9±12.5)岁,女性平均年龄(62.6±11.3)岁,所有结石标本均采用LIIR型结石红外光谱自动分析仪分析并根据结果指导预防结石复发。选取2006年1月至2008年8月86例行经皮肾镜钬激光碎石术的老年患者作为对照组,该组患者均未行结石成分分析而接受一般的预防指导。结果在结石总体构成比上,一水草酸钙结石71例(67.62%),碳酸磷灰石结石57例(54.29%),无水尿酸结石11例(10.48%),二水草酸钙结石38例(36.19%),六水磷酸铵镁结石19例(18.09%),尿酸铵结石2例(1.90%),二水磷酸氢钙结石1例(0.95%),一水尿酸钠结石2例(1.90%)。在结石的组合成分上,混合性结石76例(72.38%),单一成分结石29例(27.62%)。试验组平均随访18.6个月,复发率为8.57%。对照组平均随访24个月,复发率为18.6%,两组间复发率差异有统计学意义。结论结石成分分析对于了解老年肾结石患者结石成因、预防结石复发具有重要意义。     

不同体质指数尿路结石患者结石化学成分分析（附850例报告）

目的观察不同体质指数（BMI）尿路结石患者结石化学成分。方法根据我国BMI标准,将850例尿路结石患者分为正常组（BMI〈24）245例、超重组（BMI24—27）327例、肥胖组（BMI≥28）278例。采用傅立叶红外光谱法分析其结石化学成分。结果850例中,结石成分为草酸钙、磷酸钙、尿酸、磷酸镁铵者分别为645（75．9％）、128（15．1％）、52（6．1％）、25（2．9％）例。其中尿酸结石患者平均年龄均高于其他结石成分患者（P〈0．05）,男性比例显著高于女性（P〈0．05）;磷酸铵镁结石男性比例低于女性（P〈0．01）。正常组、超重组、肥胖组中,草酸钙结石者分别为70．2％、78．0％、78．4％（P〈0．05）,尿酸结石者分别为2．9％、7．0％、7．9％（P〈0．05）,磷酸镁铵结石者分别为7．3％、1．2％、1．1％（P〈0．01）,三组磷酸钙结石比例相近（P〉0．05）。结论BMI对结石成分有一定的影响;超重及肥胖的结石患者中,尿酸、草酸钙结石比例显著高于BMI正常的结石患者;尿酸、草酸钙结石患者应注意控制体质量。     

感染性肾结石患者尿代谢及细菌培养结果分析

［摘要］　目的　分析感染性肾结石患者的尿代谢及细菌培养结果。方法　选择2015年1月至2018年1月天津中医药大学第一附属医院收治的感染性肾结石患者87例,根据结石成分将其分为单纯感染性肾结石组［磷酸铵镁和（或）碳酸磷灰石,32例］和混合感染性肾结石组［磷酸铵镁和（或）碳酸磷灰石+草酸钙,55例］。比较两组一般临床资料、尿代谢检测结果、尿细菌培养结果及复发情况。结果　两组性别、年龄、合并糖尿病、尿石症家族史情况比较差异无统计学意义（P>0.05）。单纯感染性肾结石组有尿路感染病史及慢性尿路感染因素的人数比例大于混合感染性肾结石组,差异有统计学意义（P<0.05）。混合感染性肾结石组大肠杆菌阳性比例高于单纯感染性肾结石组,变形杆菌阳性比例低于单纯感染性肾结石组,差异有统计学意义（P<0.05）。混合感染性肾结石组高钙尿症、高草酸尿症、高尿酸尿症发生率均高于单纯感染性肾结石组,差异有统计学意义（P<0.05）。术后复查,单纯感染性肾结石组复发感染和新发结石的人数比例均高于混合感染性肾结石组,差异有统计学意义（71.88% vs 32.73%,50.00% vs 20.00%;P<0.05）。结论　与单纯感染性肾结石患者比较,混合感染性肾结石患者尿代谢异常的发生率更高,这可能与其结石成因有关,故对此类患者除了控制感染外,还应针对尿代谢异常情况进行治疗。     

上尿路结石化学成分分析及意义

目的分析上尿路结石核心、中层、外周样本的化学成分,并探讨其意义。方法取35枚直径〉0.8 cm的尿路结石,分别取其核心、中层、外周样本,采用傅立叶变换红外光谱（FT-IR）法分析其化学成分。结果纯尿酸结石4枚,混合结石31枚。24例以草酸钙为主要成分的结石核心样本中草酸钙质量分数为55.6%±9.7%,磷酸钙为33.3%±7.6%;中层样本分别为81.4%±8.6%,14.2%±2.8%;外周样本分别为86.9%±9.1%,8.7%±2.6%。7例以磷酸钙为主要成分的结石核心样本中草酸钙质量分数为7.2%±1.1%,磷酸钙为75.7%±12.7%;中层样本分别为23.6%±2.4%,66.4%±9.4%;外周样本分别为52.9%±7.6%,47.1%±7.5%。不同部位结石样本中草酸钙和磷酸钙质量分数相比P均〈0.05。不同部位结石样本中草酸钙和磷酸钙质量分数相比P均〈0.05。4例纯尿酸结石核心、中层、外周样本均由纯尿酸或尿酸盐组成,无其他成分。结论上尿路结石以混合性结石为主,最常见的成分为草酸钙与磷酸钙,其质量分数在不同层面间存在显著差异,其中磷酸钙晶体较容易出现在结石的核心,而草酸钙更易存在于外表面。磷酸钙晶体很可能是混合结石形成的共同初始原因。感染是磷酸钙晶体形成原因之一。     

单纯螺旋CT平扫在上尿路结石成分判断中的应用

目的观察单纯螺旋CT平扫在上尿路结石化学成分判断中的应用效果。方法 123枚上尿路结石,其中尿酸结石23枚、草酸钙结石41枚、磷酸钙结石10枚、碳酸钙结石8枚、草酸钙磷酸钙混合结石8例、草酸钙尿酸混合结石16例、磷酸钙尿酸结石11例、碳酸钙尿酸结石3例、草酸钙碳酸钙结石3例。采用十六排螺旋CT在患者术前行单纯平扫,参数120 kV/240 mA,螺距0.75∶1,层厚3 mm,测量结石软组织窗平均CT值。结果 82例纯结石平均CT值由高到低依次是磷酸钙（1 276.70±242.40）HU、草酸钙（1 168.71±220.73）HU、碳酸钙（703.38±129.49）HU、尿酸（535.74±172.54）HU。草酸钙与磷酸钙结石CT值相比P〉0.05,其余各类纯结石两两比较P均〈0.05。非纯尿酸结石CT值为（911.50±163.52）HU,与纯尿酸结石相比P〈0.05。CT值〈700 HU者纯尿酸结石21例、非纯尿酸结石4例,CT值≥700 HU者纯尿酸结石2例、非纯尿酸结石96例。CT值〈700 HU诊断纯尿酸结石灵敏度为91.3%、特异度为96.0%、阳性预测值为84.0%、阴性预测值为98.0%。结论单纯螺旋CT平扫用于判断上尿路结石成分效果满意。根据软组织窗CT值不同,可将体内尿酸结石与其它成分结石区分。软组织窗平均CT值〈700 HU的结石可作为纯尿酸结石的诊断标准。     

泌尿系结石成分与代谢异常的临床研究

目的探讨泌尿系结石患者的结石成分与代谢异常的关系。 方法选择2012年6月至2016年10月在佛山市南海区第二人民医院泌尿外科确诊为泌尿系结石的200例患者的临床资料,200例患者入选并参加该研究,平均年龄（36.2±3.4）岁,男女比例2:1。收集泌尿系结石患者的结石标本和血清及尿液样本,测定结石成分和血/尿代谢情况,具体测定指标为pH值、肌酐、尿酸、钙离子、磷酸盐、草酸盐、枸橼酸盐和镁离子浓度等。 结果有86（43%）例患者结石成分分析为草酸钙结石;90.5%患者存在代谢异常,最常见是高草酸尿症（64.5%）,其次是高钙尿症,高钙血症,低枸橼酸尿症和高尿酸血症。高草酸尿症易发草酸钙结石、草酸钙/磷酸钙及草酸钙/尿酸混合成分结石;低枸橼酸尿症易发草酸钙、磷酸钙结石;高钠血症及高尿酸血症都易发草酸钙结石;高胱氨酸血症易发胱氨酸结石。 结论代谢异常在泌尿系结石患者中常见,大多数为高草酸尿症、高钙尿症、高钙血症、低枸橼酸尿症、高尿酸血症。代谢异常容易诱发结石,结石成分和代谢异常分析有助于选择合适的医学治疗和调整饮食习惯来预防结石复发。     

双肾多发结石、高草酸尿症、肾功能不全

12岁男性,因"多发肾结石6年,血清肌酐升高8月,加重1月余"入院。患者临床表现双肾多发结石,缓慢进展至慢性肾功能不全;结石成分分析为"一水草酸钙",其父亲患有肾结石。结合临床、实验室检查、GRHPR基因分析诊断为原发性高草酸尿症2型,高草酸尿症导致肾损害。     

MPCNL结合ESWL治疗复杂性肾结石27例疗效观察

目的 探讨经皮肾微造瘘输尿管肾镜钬激光碎石（MPCNL）结合体外冲击波碎石术（ESWL）治疗复杂性肾结石的疗效。方法对27例复杂性肾结石患者采用MPCNL一次或多次,结合一次或多次ESWL碎石治疗。结果治疗后结石取净24例（88．9％）,残余结石2例,因经皮肾微造瘘失败放弃1例。术后出现高热3例。均未出现手术相关并发症。结论MPCNL结合ESWL治疗复杂性肾结石安全、有效,值得临床借鉴。     

十年来国外口服药物防治肾结石进展

肾结石是当今一顽疾。手术除石为重要对策,然而未能阻止其复发,复发率甚至可高达80%。近年来,随着对结石形成机制的深入研究,采用口服药物防治肾结石,尤其是特发性肾结石,取得较多进展。肾结石的晶体成份,约3/4以上含钙盐,其中以草酸钙为最多。结石之所以形成,主要取决于尿液所含晶体饱和度与尿液抑制活力之比。因此,药物治疗旨在减少尿钙等晶体成分和/或增加尿液抑制活力。正磷酸盐(Orthophosphate) 目前用于防治肾结石的各种‘磷’制剂中,应用最广,疗效较好而副作用较少的是正磷酸盐。临床上约有2/3肾结石无明确病因可查,此种所谓特发性肾结石的治疗最棘手。其     

Predictive value of kidney stone composition in the detection of metabolic abnormalities

PURPOSE: To determine if kidney stone composition can predict the underlying medical diagnosis, and vice versa. METHODS: We studied 1392 patients with kidney stones who underwent a complete ambulatory evaluation and who submitted one or more stones for analysis. We ascertained the associations between medical diagnosis and stone composition. RESULTS: The most common kidney stones were composed of calcium oxalate (n = 1041 patients [74.8%]), mixed calcium oxalate-calcium apatite (n = 485 [34.8%]), and calcium apatite alone (n = 146 [10.5%]). The most common medical diagnoses were hypocitraturia (n = 616 patients [44.3%]), absorptive hypercalciuria (n = 511 [36.7%]), and hyperuricosuria (n = 395 [28.4%]). Calcium apatite and mixed calcium oxalate-calcium apatite stones were associated with the diagnoses of renal tubular acidosis and primary hyperparathyroidism (odds ratios >/=2), but not with chronic diarrheal syndromes. As the phosphate content of the stone increased from calcium oxalate to mixed calcium oxalate-calcium apatite, and finally to calcium apatite, the percentage of patients with renal tubular acidosis increased from 5% (57/1041) to 39% (57/146), and those with primary hyperparathyroidism increased from 2% (26/1041) to 10% (14/146). Calcium oxalate stones were associated with chronic diarrheal syndromes, but not with renal tubular acidosis. Pure and mixed uric acid stones were strongly associated with a gouty diathesis, and vice versa. Chronic diarrheal syndromes and uric acid stones were associated with one another, and brushite stones were associated with renal tubular acidosis. As expected, there was a very strong association between infection stones and infection, and between cystine stones and cystinuria. CONCLUSION: Stone composition has some predictive value in diagnosing medical conditions, and vice versa, especially for noncalcareous stones.     

Biochemical and bacteriological study of urinary calculi.

Biochemical and bacteriological study of urine, nidus and chemical analysis of 100 calculi from 100 patients admitted in the Regional Institute of Medical Sciences, Imphal from November, 1997 to October 1999 were done. About 47% of the cases had positive urine culture and nidus culture. Escherichia coli was the commonest bacteria isolated both in the urine and nidus of calculi. The commonest radical present in the calculi was calcium while the rarest was uric acid. The stones were composed mainly of calcium oxalate and/or phosphate followed by struvite, then mixed stone.     

A statistical survey of the composition of gallstones in eight countries

The crystalline composition of gallstones from Australia, England, Germany, India, Kuwait, South Africa, Sweden, and the USA has now been determined by the x-ray powder method. Eleven compounds were identified. The three cholesterols-cholesterol monohydrate, anhydrous cholesterol, and cholesterol II-account for 71% of the total crystalline material in the stones; the calcium carbonates-vaterite, aragonite, and calcite-contribute 15%, and calcium palmitate contributes 6%. Smaller amounts of apatite, sodium chloride, whitlockite, and alpha-palmitic acid were also found. The composition distribution in each country is significantly different. Gallstones from Germany, Sweden, and Australia are the most similar. Gallstones from England have significantly more carbonate, and stones from South Africa have much less cholesterol and more calcium phosphate and calcium palmitate. Stones from Kuwait have a large amount of calcium palmitate and those from India an excess of calcium phosphate. The composition of stones related to the age and to the sex of a patient shows that although there are no significant differences in composition for patients under and over the age of 50 there are differences in the stone composition related to the patient's sex. Female patients form much more cholesterol while males form much more calcium palmitate and slightly more calcium carbonate. The differences also exist for female and male patients over and under 50 years of age. A study of the texture and orientation of the crystalline material in the gallstones has shown that anhydrous cholesterol and cholesterol monohydrate can occur as single crystals oriented with respect to the nucleus whereas other stone components are disoriented crystallites.     

Using computed tomography to predict in vivo stone chemical composition

OBJECTIVES. Several authors hypothesized the usefulness of the non-contrast helical computed tomography (NCHCT) with the determination of stone Hounsfield Unit (HU) values in order to predict urinary stone compositions. Preoperative knowledge of stone composition might be interesting in pre-operative decision-making process. The aim of this study was to evaluate the possible correlation between stone chemical composition and correspondent stone HU value in an in-vivo experience. METHODS. Forty patients with urinary stones were preoperatively studied with abdominal NCHCT, where stone HU values were reported. Stone chemical composition was obtained in each patient, using the colorimetric method. The HU value of each stone was compared with the correspondent chemical analysis. Results. The median HU values of calcium oxalate (n=10), mixed calcium oxalate and phosphate (n=19), calcium phosphate (n=2), uric acid (n=6) and mixed uric acid and calcium oxalate (n=3) stones were 1060 HU [interquartile range (IQR) 743.75-1222.5]; 900 HU (IQR 588.5-1108.5); 774 HU (range 720-828); 371 HU (IQR 361.25-436.25) and 532 HU (range 476-626), respectively. CONCLUSIONS. Our results confirmed a statistically significant difference of the HU values between calcium and pure uric acid calculi, suggesting a correlation between stone chemical composition and CT-density. Hounsfield unit.     

X-ray diffraction studies of the composition of gallstones from English and Australian patients

The crystalline composition of two collections of gallstones from patients in England and Australia have been determined by the x-ray powder diffraction technique. Twelve substances have been identified including a form of cholesterol which hitherto has not been reported. The weighted percentage composition averaged over each collection shows that cholesterol is the major constituent of the Australian stones and cholesterol and cholesterol monohydrate the major constituents of the English calculi. The cholesterol is possibly a decomposition product of the monohydrate. The calcium carbonates-calcite, aragonite, and vaterite-constitute most of the remainder of the calculi. Although their percentage composition is much smaller than that of the cholesterols, they are nevertheless present in a high proportion of stones. Small traces of apatite, whitlockite, sodium chloride, calcium stearate and palmitic acid (or other long-chain compounds having closely related spacings) have been found. Small spheroids scattered throughout some stones appear to be mainly calcium stearate, although the total quantity available is too small and too impure for a definite identification.     

Renal function in patients with urinary stones of varying compositions

Kidney stones are a potential risk factor for chronic kidney disease. The impact of different urinary stone components on renal function is unknown. In this study, we retrospectively reviewed 1,918 medical records of patients with urolithiasis. The renal function was evaluated as estimated glomerular filtration rate. All the stones were analyzed by Fourier transform infrared spectroscopy. The patients were divided into five groups according to the stone components. Statistical analysis was performed with analysis of variance. All the patients with stones had Stage 2-3 chronic kidney disease. The patients with uric acid and struvite stones had significantly lower estimated glomerular filtration rate compared with those having other stone components (p<0.01). Furthermore, the patients with calcium-containing stones (calcium oxalate and calcium phosphate) had significantly better renal function than those with non-calcium-containing stones (struvite and uric acid, p<0.01). Patients with urolithiasis had decreased renal function, and the impact of renal function varied depending on the stone components. We conclude that stone analysis is important in predicting the change in renal function in patients with urolithiasis. Moreover, the patients with non-calcium-containing stones, such as struvite and uric acid stones, should be carefully evaluated and treated to preserve their renal function.     

An X-ray diffraction study of the crystalline composition of gallstones

The crystalline composition of gallstones removed from 30 patients from southwestern Finland was determined by the X-ray powder method. A total of eight crystalline compounds, varying from one to four per stone, were identified. Anhydrous cholesterol was by far the most abundant compound, occurring in 29 patients (97%), and calcium salts occurred in half the material studied. The stones could be classified on the basis of crystalline composition: pure cholesterol stones (40%), stones of cholesterol and calcium carbonate (37%), stones of cholesterol and sodium chloride or/and calcium palmitate (20%), and a stone of apatite and calcium carbonate (3%). The average amount of crystalline components per stone was as follows: cholesterols, 82%; calcium carbonates, 14%; and the rest, apatite, calcium palmitate, and sodium chloride. The crystalline composition of the stones related to the sex and age of the patients indicated several trends, including the occurrence of calcium carbonates in the stones of patients over 50 years of age and their simultaneous occurrence in small stones and with the cholesterols. Calcium palmitate was also more frequently present in the calculi of male patients.