性激素与尿路草酸钙结石

性别是尿石形成的一个危险因素。尿路结石中 ,80 %是草酸钙结石 ,目前有关性激素与尿石形成的研究也主要集中在草酸钙结石。一般认为 ,睾酮对尿石形成有促进作用 ,而雌激素则可抑制成石。性激素影响尿石形成的确切机制尚不清楚。1　睾酮1 .1　流行病学尿石症患者中 ,男女比例为 2～ 3∶1,而对特发性钙盐结石 ,男性的易患率比女性高 4～ 5倍[1] 。Ｋｕｃｚｅｒａ等[2 ] 比较了 2 6例男性肾结石患者和 14名健康男性 ,发现前者的雄激素、尿草酸和尿钙均高于后者。这些均提示睾酮在尿路结石的发生中有重要作用。1 .2　睾酮与尿石形成的相关研究…     

维生素D和维生素K对大鼠结石模型尿晶体成分的影响

目的进一步明确维生素D和维生素K与肾结石的关系,探讨成石机制。方法将健康成年雄性SD大鼠24只随机分成4组,即对照组、诱石组、维生素D组和维生素K组,收集第1、3、7天约24小时尿,测定尿晶体成分的浓度。结果维生素D组尿钙和草酸明显高于对照组和诱石组,尿镁和柠檬酸显著降低（P＜0．05）。维生素K组尿草酸明显低于诱石组（P＜0．05）。结论维生素D可能通过多种机制促进肾结石形成,而维生素K有抑制结石形成的作用。     

维生素K对肾结石患者尿抑制作用的影响

为了解维生素Ｋ在尿石形成中作用，用超滤法分离正常人和草酸钙肾结石患者尿中大分子物；结合草酸耐受试验，检测肾结石患者应用维生素Ｋ前后尿不同分子量物质的草酸耐受量。结果：正常人及肾结石患者尿分子量１００００～３００００大分子物草酸耐受量最高；肾结石患者较正常人草酸耐受量低（分别为２．７２±０．７４ｍｌ和３．７５±０．３５ｍｌ，Ｐ＜０．０５）；肾结石患者应用维生素Ｋ后尿１００００～３００００大分子物草酸耐受量增加（３．１９±０．５７ｍｌ，Ｐ＜０．０５）。提示尿中草酸钙结石抑制物主要为分子量１００００～３００００的大分子物，维生素Ｋ应用后明显改善肾结石患者尿抑制作用     

肾开放性手术中单根导管双向引流的应用

目的总结单根导管双向引流在肾开放性手术中治疗复杂肾结石的应用经验。方法回顾性分析158例复杂肾结石患者在肾开放性手术中应用单根导管双向引流的临床资料，手术中均行肾盂、肾实质切开取石并置单根导管双向引流。结果158例患者手术切口无一例感染和尿瘘形成。结论肾开放性手术治疗复杂肾结石后单根导管双向引流可缩短漏尿时间，有效防止切口感染、尿瘘形成及其他置管方法引起的并发症，方法简单，便于掌握。     

半量尿石通对含钙尿石形成患病因素的影响

目的分析半量尿石通对含钙尿石形成的影响。方法门诊肾结石患者22例,进行自身对照研究,比较服用半量尿石通1个月前后尿p H值、钙、磷、草酸、尿量、尿酸、酸性黏多糖的变化。结果排出结石7例(31.8%),发生肾绞痛1例,口服扶他林后缓解。均无因不能耐受而中断治疗者,服药期间无明显不良反应发生。钙、磷、草酸、p H值、酸性黏多糖及结石形成概率指数服药后明显改变(P0.05),尿酸和尿量无明显改变(P0.05)。结论使用半量尿石通并延长用药时间,对于含钙尿石形成的患病因素有影响,可降低结石形成概率指数。     

经皮肾镜碎石取石术辅用尿石净汤治疗肾结石的疗效观察

目的观察经皮肾镜碎石取石术辅用尿石净汤治疗肾结石的临床疗效。方法选取本院2008年7月至2011年10月收治的85例肾结石患者,行经皮肾镜碎石取石术,术后服用中药尿石净汤进行联合治疗。结果85例肾结石患者PCNL手术成功率为100％。I期净石率67．1％（57／85）,内服中药尿石净汤30天后,净石率达95．3％（81／85）,较I期手术净石率显著改善（X2=22．17,P〈0．01）。结论经皮肾镜碎石取石术辅用尿石净汤治疗肾结石术中损伤小、净石率高、少并发症,可I临床推广应用。     

草酸钙尿结石患者肾组织维生素K依赖羧化酶活性的研究

目的　探讨草酸钙尿石患者肾组织内维生素K依赖羧化酶 (VKDC)活性变化及其意义。　方法　收集 2 1例肾结石及肾肿瘤患者肾组织 ,超速离心提取羧化酶 ,运用同位素标记的羧化反应检测尿石患者肾组织维生素K依赖羧化酶活性。　结果　两组草酸钙尿石患者肾组织内VKDC活性分别为 (5 80± 16 6 )cpm/mg和 (44 5± 16 2 )cpm/mg ,明显低于正常肾组织 (810± 90 )cpm/mg ,差别有显著性意义 ,P <0 .0 5。 　结论　草酸钙尿石患者肾组织内VKDC降低在草酸钙尿石形成中有重要作用     

导尿管留置时间对肾结石术后患者尿枸橼酸浓度的影响

目的探讨肾结石术后患者导尿管不同留置时间对尿液中结石抑制物枸橼酸浓度的影响,为肾结石术后患者导尿管最佳留置时间提供依据。方法对42例肾结石手术留置导尿管患者采用分光光度计比色法测定其术前1d及术后第3、5、7、10天的24h尿枸橼酸浓度。结果导尿管留置不同时间患者尿枸橼酸浓度比较,差异有统计学意义(P0.01);术前1d及术后第10天24h尿枸橼酸浓度与术后第3、5、7天比较,差异有统计学意义(P0.05,P0.01)。结论肾结石术后患者导尿管留置时间不宜超过10d,否则有可能致尿枸橼酸浓度降低,利于尿石形成,使结石复发。     

导尿管留置时间对肾结石术后患者尿枸橼酸浓度的影响

目的探讨肾结石术后患者导尿管不同留置时间对尿液中结石抑制物枸橼酸浓度的影响．为肾结石术后患者导尿管最佳留置时间提供依据。方法对42例肾结石手术留置导尿管患者采用分光光度计比色法测定其术前1d及术后第3、5、7、10天的24h尿枸橼酸浓度。结果导尿管留置不同时间患者尿枸橼酸浓度比较,差异有统计学意义（P〈0．01）;术前1d及术后第10天24h尿枸橼酸浓度与术后第3、5、7天比较,差异有统计学意义（P〈0．05,P〈0．01）。结论肾结石术后患者导尿管留置时间不宜超过10d,否则有可能致尿枸橼酸浓度降低,利于尿石形成,使结石复发。     

哈尔滨地区含钙尿结石形成的病因素分析

实验证实含钙尿石形成的患病因素主要与尿钙和草酸有关,因此防治尿石主要是控制高尿酸、高草酸。限制能增加草酸的菠菜、茶、巧克力酪制品、维生素 B 及维生素 C 等。限制能增加尿酸的肉类食品,提倡多吃些纤维素和维生素 B_6多的粗食。     

雌激素抑制肾草酸钙结石形成机制的研究进展

肾结石多为草酸钙结石,为外科常见病,发病率逐年升高.近年来,研究发现雌激素与草酸钙结石之间关系密切.众所周知,男性肾结石的患病率普遍高于女性.多项研究表明,雌激素缺乏的女性更易患有肾结石,有更高的尿草酸及尿钙排泄量.雌激素作为草酸钙结石的抑制剂,其在多种与草酸钙结石形成相关的机制中发挥关键作用,如促进骨桥蛋白(oste...     

Cystine urolithiasis in Finland

Cystine stone material was collected from 27 patients treated in various hospitals in Finland. The prevalence of cystine stones was found to be one/year/1,000,000 inhabitants. A total of 49 operations were performed on 20 patients, with five nephrectomies carried out as the first stage of treatment in the patients with stones. Extracorporeal shock wave lithotripsy (ESWL) failed to fragment cystine stones in one patient and percutaneous stone removal was necessary. The delay in the diagnosis of cystinuria averaged 5.1 years. Most patients with cystine stones had homozygous cystinuria. Anuria due to recurrent stone formation occurred in three patients. Chronic urinary tract infection was seen in nine out of 15 (60%) women patients and four of these nine had inflammatory changes in the kidneys diagnosed by urography. Early diagnosis of cystinuria is important to avoid kidney injury and recurrence of cystine stones.     

Surgical treatmnt for urolithiasis (in view of medical economics)

Surgical treatment for upper urinary stones has dramatically changed since extracorporeal shock wave lithotripsy (ESWL) was introduced in 1985 in Japan. Since then, the number of ESWL apparatus is increasing year by year, and there were about 800 ESWL apparatus available in Japan in 2001. On the other hand, the number of patients with upper urinary stones are also increasing in Japan, and the age-adjusted annual incidence of first-episode upper urinary tract stones in 1995 was estimated at 68.9 per 100,000 (100.1 in men and 55.4 in women), a steady increase from 54.2 in 1965. Under these circumstances, it would be very important to treat stone patients surgically even from an economical point of view, because the cost of ESWL is very expensive and more than 90% of the patients with urolithiasis are now treated by ESWL. In this paper, the medical economics of urolithiasis in Japan is discussed especially in the surgical treatment.     

特发性高钙尿与骨质疏松的研究进展

特发性高钙尿症(idiopathic hypercalciuria,IH)主要有两大危害,一则影响骨代谢,容易引起骨量减少、骨质疏松,增加骨折风险;二则影响泌尿系统,主要表现为增加患肾结石风险。高钙尿引起骨质疏松及肾结石的具体机制尚不明确。现有的研究表明核因子κB受体活化因子配体(RANKL)/核因子κB受体活化因子(RANK)/护骨素(OPG)通路激活可能是IH患者引起骨质疏松的主要机制之一。雌激素缺乏会引起尿钙升高、骨量减少,是高钙尿及骨质疏松的重要病因。高钙尿症还可能通过单核细胞趋化因子-1(MCP-1)等细胞因子的增加从而引起骨量减少。对遗传因素的研究中发现了许多与高钙尿及骨量减少相关联的基因,主要包括降钙素受体基因、瞬时感受器电位阳离子通道香草精受体5基因、维生素D受体基因。但对上述一些基因型与骨质疏松的研究存在不同的结论,而雌激素缺乏还可通过影响瞬时感受器电位阳离子通道香草精受体5基因的表达起作用,因此遗传因素可能成为未来研究的热点。     

Effects of therapy with bendroflumethiazide in patients with recurrent renal calcium stones.

Forty-four patients with recurrent formation of calcium-containing renal stones were treated with bendroflumethiazide for at least 2 years. Prior to treatment each patient had formed, on average, one stone per year for 8 years; during treatment only 4 patients formed new stones. A reduction in urinary calcium excretion was seen in almost all patients irrespective of their initial urinary calcium level. The apparent clinical benefit was not related to pre-treatment urinary electrolyte levels. Side effects were slight: one patient developed symptomatic hyperuricaemia and in one case sustained hypercalcaemia was found. Long-term treatment with thiazides appears to be a safe and effective method for the prevention of recurrent calcium stones.     

Preventive effects of green tea on renal stone formation and the role of oxidative stress in nephrolithiasis

PURPOSE: Urinary stones are similar to arteriosclerosis in epidemiology, mechanism, calcification composition and age at frequent occurrence. The calcification that occurs in arteriosclerosis is inhibited by antioxidants. Green tea leaves contain approximately 13% catechins, which have been shown to have antioxidant effects. We investigated the inhibitory, antioxidative effects of green tea on calcium urinary stone formation. MATERIALS AND METHODS: A total of 120 Wistar rats were divided into 4 groups, namely group 1-control rats receiving saline, group 2-stone group rats administered ethylene glycol (EG) and vitamin D3, group 3-drink group rats administered EG, vitamin D3 and green tea given as drinking water, and group 4-powder group rats administered EG, vitamin D3 and 2.5% powdered green tea leaves mixed in a powder diet. Pooled 24-hour urine samples and blood samples were collected and the 2 kidneys were excised 7, 14 and 21 days after administration, respectively. One kidney was used for immunohistological examination of osteopontin, superoxide dismutase (SOD), p65, p53 and bcl-2 expression, in situ hybridization of osteopontin and detection of apoptosis, while the other was used for quantitative analysis of SOD activity. RESULTS: Green tea treatment decreased urinary oxalate excretion and calcium oxalate deposit formation. Green tea treatment increased SOD activity compared with the stone group. The degree of apoptosis in the stone group was significantly increased compared with the drink and powder groups. CONCLUSIONS: The inhibitory effect of green tea on calcium oxalate urolithiasis is most likely due to antioxidative effects.     

ESWL与输尿管镜碎石联合处理上尿路结石

目的：探讨对部分上尿路结石采用ESWI．与输尿管镜碎石联合处理的方法。方法：对70例上尿路结石患者采用ESWI。与输尿管镜下钬激光碎石（URS）联合交替治疗。其中输尿管结石48例,。肾结石22例。结果：结石总排净率为91．4％00（64／70）,其中输尿管结石排净率为95．8％（46／48）,肾结石排净率为81．8％（18／22）。3例治疗失败,其中1例输尿管结石因输尿管狭窄无法入镜;另2例肾结石,1例因交替治疗次数过多中途停止治疗,1例因结石硬度过大ESWI,不佳,均改为PCNL术。结论：ESW[。与URS联合交替进行的疗法处理上尿路结石,避免了创伤性治疗,扩大了ESWI,治疗范围,降低了URS手术难度,缩短了URS操作时间,提高了结石排净率,患者创伤微小、恢复快、并发症少,是治疗上尿路结石,特别是部分复杂性上尿路结石较理想的方法之一。     

Pathogenesis of nephrolithiasis post-partial ileal bypass surgery: case-control study. The POSCH Group

Between 1975 and 1983, 838 patients were randomized into the Program on the Surgical Control of Hyperlipidemias (POSCH) trial: 417 to standard medical care and 421 to partial ileal bypass (PIB) surgery. During the course of the trial, an increased incidence of kidney stone formation was found in the surgery group (4%/year) as compared to the control group (0.4%/year). A matched triplet case-control study was conducted to assess the possible causes for the increased incidence of kidney stones. Three groups were studied: PIB stone-formers (S); PIB non-stone formers (N); and non-PIB, non-stone formers in the control group (C). Initially, 162 patients (54 triplets) were selected. Ten percent of the patients declined to participate which resulted in a sample size of 146 patients. The PIB patients had statistically significant (P less than 0.05) lower levels of serum vitamin D metabolites; lower urine volume, pH, citrate, magnesium, carbon dioxide, and sulfate, and higher urinary oxalate, ammonia and relative supersaturation for calcium oxalate and uric acid than the control patients. Although S and N had similar results, those S with no prior history of stones had a higher calcium oxalate supersaturation than similar N with a negative prior history of stones (P less than 0.025). Based on these results, all PIB patients appear to be at risk for kidney stone formation. The combination of reduced urinary volume and calcium oxalate precipitation inhibitor substance with increased calcium oxalate relative supersaturation produced an increase in nephrolithiasis risk in the PIB groups.     

Current trend and risk factors for kidney stones in persons with spinal cord injury: a longitudinal study

STUDY DESIGN: A multi-center longitudinal study. OBJECTIVES: To estimate the current trend in the incidence of first kidney stone among persons with spinal cord injury (SCI) and to delineate the potential contributing factors. SETTING: Twenty-one Model SCI Care Systems throughout the United States. METHODS: A longitudinal cohort of 8314 subjects enrolled in the National SCI Database between 1986 and 1999 was used to estimate and compare the incidence of first kidney stone with a previous report of 5850 SCI patients injured between 1973 and 1982. A Cox regression analysis was performed to identify risk factors for stones, including age, race, gender, severity of injury, and method of urinary drainage. These variables have been routinely collected, on a yearly basis, by the collaborating SCI centers. RESULTS: During the 12 years, 6 months of case ascertainment, 286 incident stone cases were documented. The risk was greatest during the first 3 months after injury (31 cases per 1000 person-years), quickly decreasing and leveling off later (eight cases per 1000 person-years). It was estimated that within 10 years after injury, 7% of persons with SCI would develop their first kidney stone. There was no evidence that the risk has changed over the past 25 years (P=0.96). During the first year post injury only, a significantly increased risk of stones was observed in Caucasians and persons aged 45 years or older. A positive association of the severity of injury and requiring instrumentation for bladder emptying with kidney stones was found after the first year post injury. The type of urinary drainage, including indwelling, intermittent, and condom catheterization, had no significant differential effect on stone formation at either risk period. CONCLUSIONS: The highest risk of kidney stones is within the first few months post injury. Little progress has been made in reducing this risk. Although inability to control bladder function is an important risk factor after the first year post injury, for those who need bladder management, the type of urinary drainage does not appear to be an important factor in determining risk. Spinal Cord (2000) 38, 346 - 353.     

Endoscopic management of upper urinary tract stones.

In a two year period from March 1983, 157 patients with upper urinary tract stones were managed primarily by endoscopy. Of 90 patients with renal stones, extraction was achieved in 91% of patients with complete extraction in 76%. Of the remaining patients with ureteric stones, successful extraction was achieved in 75%. Ten patients required open surgery which was for failed extraction in 9. Morbidity is low with a mean hospital stay of 4.7 days for patients with kidney stones, and of 3.7 days for patients undergoing extraction of ureteric stones.