飞行人员泌尿系结石的病因学病例对照研究

目的:对飞行人员泌尿系结石作病因学回顾性研究,探讨飞行环境、饮食等因素对飞行人员泌尿系结石形成的影响,旨在降低飞行人员泌尿系结石的发病率,并针对高危因素给予预防性的生活指导。方法:采用配对病例对照研究,制作规范化问卷表,对45例曾患泌尿系结石的男性飞行人员以及与其1:2配对对照的同单位健康飞行人员和地勤人员进行问卷调查及随访,运用逻辑回归分析其在飞行、训练、饮食等方面的差异。结果:每日饮水量与泌尿系结石的发生有相关性,每日饮水量<1 200ml为泌尿系结石发生的危险因素,OR值为3.234;每日蛋白质摄入量与泌尿系结石的发生有相关性,每日蛋白质摄入量>90g为泌尿系结石发生的危险因素,OR值为2.205;饮酒与否及饮酒量与肾结石的发生无关;饮水的种类以茶或白开水为主也与肾结石无相关性。结论:飞行人员泌尿系结石发病风险与每日饮水量成负相关,与动物蛋白质摄入量成正相关。     

泌尿系结石成分分析与血脂相关性研究

目的分析泌尿系结石成分及其与血脂[甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]相关性。方法回顾性选择2014年10月～2018年10月我院收治的349例泌尿系结石患者为尿石组,同期在我院体检健康者349例为对照组,比较两组血清TG、HDL-C、TC、LDL-C水平,分析349例泌尿系结石患者泌尿系结石成分,比较血脂正常与血脂异常的泌尿系结石患者结石成分占比,采用spearman相关分析泌尿系结石成分与血脂异常的相关性,采用多因素Logistic回归分析泌尿系结石的影响因素。结果 349例泌尿系结石患者泌尿系结石成分分析结果:含钙结石270例,感染性结石51例,尿酸结石28例。尿石组血清TG、TC水平显著高于对照组(P0.05);尿石组血清HDL-C水平显著低于对照组(P0.05);尿石组血清LDL-C水平较对照组差异无统计学意义(P0.05);血脂异常泌尿系结石患者尿酸结石比例显著高于血脂正常泌尿系结石患者(P0.05);血脂异常泌尿系结石患者感染性结石、含钙结石比例较血脂正常泌尿系结石患者差异无统计学意义(P0.05);尿酸结石与血脂异常呈正相关(P0.05);感染性结石、含钙结石与血脂异常无相关性(P0.05);TG是泌尿系结石的危险因素(P0.05)。结论泌尿系结石形成与血脂水平关系密切,血脂异常尤其是高甘油三酯血症易导致尿酸结石形成,控制血脂对于预防泌尿系结石有重要临床意义。     

结石类型与年龄、性别的相关性研究

目的:对结石成分进行定量分析,探讨结石类型与患者人口学特征、基础疾病等因素的关系。方法:回顾性分析336例泌尿系结石患者,根据结石类型分为单纯草酸钙结石组、草酸钙混合结石组、磷酸钙混合结石组、尿酸结石组、磷酸铵镁结石组、其他成分组。比较不同组间患者年龄、性别、BMI、基础疾病的差异。对单因素分析中P<0.20的影响因素进行多分类Logistic回归分析。结果:所有结石患者中,上尿路结石322例,依次为单纯草酸钙结石(53.1%)、草酸钙混合结石(26.7%)、磷酸钙混合结石(10.9%)、尿酸结石(6.5%)、磷酸铵镁结石(2.2%)、其他结石(0.6%)。单因素分析结果显示,不同组间患者的性别、年龄差异有统计学意义(P<0.05),不同组间患者的BMI、基础疾病差异无统计学意义(P>0.05)。多因素分析结果显示,与老年患者相比,青年患者草酸钙混合结石、磷酸钙混合结石和尿酸结石的优势比(OR)分别为2.47、20.74和0.20(P<0.05);中年患者草酸钙混合结石和磷酸钙混合结石的OR值分别为2.31和7.70(P<0.05)。与男性患者相比,女性患者磷酸钙混合结石和磷酸铵镁结石的OR值分别为5.20和6.74(P<0.05)。结论:不同结石类型的患者具有不同的人口学特征,在年龄和性别上均有明显差异。     

骨折患者电解质紊乱及其影响因素

目的了解骨折患者电解质代谢紊乱情况,分析其影响因素。方法回顾性分析2018年1月至12月四川省人民医院收治的骨折患者(骨折组,n=1 007)和同期体检人群(对照组,n=100)的临床资料,比较两组患者血清钾、钠、氯、钙、镁、磷含量,分析性别、年龄、失血量和骨折部位、受伤时间、合并疾病(糖尿病、肾功能不全、骨质疏松)对骨折患者电解质的影响。结果骨折组血清钾、钠、钙、镁、磷含量明显低于对照组,两组比较,差异有统计学意义(P 0.05)。男性骨折患者血镁、磷含量均值低于女性,钙、镁、磷含量低于正常值的比率高于女性;较青壮年,老年骨折患者血清钾、镁含量较高,而氯、钙含量较低(P 0.05)。骨折失血量越多,血钙越低;多部位或骨盆髋臼骨折患者血钙含量低于锁骨、尺桡骨等部位骨折患者(P 0.05)。随着受伤时间的延长,血钾、钠、氯、钙含量逐渐下降,尤以血钙明显;血镁、磷则缓慢升高。合并糖尿病患者骨折后血糖和血钾含量呈正相关;肾功能不全患者骨折后钾、磷明显高于肾功能正常者,血氯则相对较低(P 0.05);骨质疏松患者骨折后血钙、磷较骨质正常者偏低,但差异无统计学意义(P0.05)。结论与体检人群相比,骨折患者血钾、钠、钙、镁、磷含量明显降低;失血量、骨折部位、受伤时间、合并疾病(糖尿病、肾功能不全)等因素影响骨折患者的电解质代谢。     

山东烟威地区1 146例泌尿系结石成分分析

目的分析山东烟威地区1 146例泌尿系结石的成分, 为本地区的结石预防提供依据。方法选取2017年5月至2020年10月在本院收治的1 146例泌尿系结石的结石标本, 应用红外光谱法进行结石成分测定, 并结合临床资料进行统计分析。结果泌尿系结石最多见的为输尿管结石(68.85%)。上尿路结石主要成分以一水草酸钙为主, 下尿路结石主要成分以无水尿酸为主。多数不同成分结石的男性患者多于女性患者(P<0.05), 但感染性结石(主要以六水磷酸铵镁为主)是女性患者高于男性患者(P<0.05)。结论对山东烟威地区泌尿系结石患者根据结石分布特点及成分分析针对性的采取相应的治疗、预防措施, 在临床结石疾病的治疗、预防及减少复发中具有重要意义。     

合肥市3860例妊娠中、晚期孕妇全血微量元素检测结果分析

目的了解合肥地区孕妇全血微量元素水平,为合理补充微量元素和孕期指导提供科学依据。方法以原子吸收光谱法测定3 860例于安徽医科大学第一附属医院绩溪路门诊部产检的中、晚期孕妇血中铜、锌、钙、镁、铁5种微量元素的含量,以体检中心50例非孕期育龄女性作为对照组,分析比较各组间的微量元素含量差异,并与已发表的其他地区相关文献的检测结果进行比较。结果全部3 860例孕妇血微量元素水平检测值高于正常参考区间者占0.05%;低于正常参考区间者占25.60%,其中锌占1.74%、钙占3.47%、镁占0.05%、铁20.34%。孕妇组血铜、锌水平显著高于对照组(P<0.05),血镁、铁水平显著低于对照组(P<0.001),血钙水平组间无统计学差异(P>0.05);与对照组比较,妊娠中、晚期血铜水平均显著升高(P<0.05),妊娠中期血镁、铁水平显著降低(P<0.05),妊娠晚期血锌水平显著升高(P<0.05)而血镁、铁水平显著降低(P<0.05)。与相关文献报道比较,本次检测结果显示孕妇血铜、锌、钙、镁水平基本正常,血铁水平随孕周增加有明显缺乏。结论合肥市城区内...     

广东东江流域泌尿系结石患者中尿酸结石的比例和代谢特点

目的 分析广东东江流域泌尿系结石患者中尿酸结石的比例及其代谢特点.方法 对东江流域290例泌尿系结石患者的结石样本进行红外光谱定性分析,调查尿酸结石所占比例.对尿酸结石患者进行1∶1配对病例对照研究,通过条件logistic回归处理资料,分析饮食危险因素.对尿酸结石患者、草酸钙患者和正常人进行广泛式代谢评估并行组间比较,分析尿酸结石形成的代谢性因素.结果 290例泌尿系结石中含尿酸结石有53例,占18.3%.多因素的条件logistic回归显示饮水量少、口味咸、喜食肉和少食蔬菜是尿酸结石形成的主要饮食危险因素.尿酸结石组尿量、尿pH值、尿钙、尿草酸,血钙浓度显著低于草酸钙组;尿尿酸和血尿酸浓度显著高于草酸钙组;尿量、尿pH值、尿草酸、尿枸橼酸均显著低于正常对照组;尿尿酸、尿钙和血钠、钙、尿酸显著高于正常对照组,血钾、镁显著低于正常对照组.结论 广东东江流域泌尿系结石患者尿酸结石的比例较高,其饮食危险因素为饮水少、口味咸、海鲜摄入多;低尿量、低pH尿、高尿酸、高钙尿、低枸橼酸尿、高血钠、低血钾、高血钙、高尿酸、低血镁是尿酸结石形成的重要代谢因素.     

排石汤对草酸钙泌尿系结石患者尿液成分的影响

目的探讨排石汤对经尿道输尿管镜碎石术(URL)后草酸钙泌尿系结石患者尿骨桥蛋白(OPN)、尿钙、尿草酸钙的影响。方法选取2018年6月至2022年6月在本院收治的80例草酸钙泌尿系结石患者, 随机分为对照组(40例)和观察组(40例)。观察组服用排石汤, 连用3个疗程;对照组给予同等量安慰剂(5%排石汤及食用色素组成)。分别检测两组患者术前、术后第1、7、14、21、28天的尿OPN、尿钙、尿草酸钙含量。结果与术前比较, 术后第7、14、21、28天两组的尿OPN含量均呈上升趋势, 尿钙、尿草酸钙含量均呈下降趋势, 差异均有统计学意义(均P<0.05);但术后第1天与术前比较, 两组的尿OPN、尿钙、尿草酸钙含量比较, 差异均无统计学意义(均P>0.05);而术后第7、14、21、28天, 观察组的尿OPN含量均高于对照组, 尿钙、尿草酸钙含量均低于对照组(均P<0.05)。结论草酸钙泌尿系结石患者URL术后应用排石汤, 对提高尿OPN含量及降低尿钙、尿草酸钙含量有明显帮助。     

精液质量与精浆微量元素关系探讨

作者采用 ICP 光谱法对86例不同质量的精液进行了微量元素分析。发现精浆中含有锌、铝、铁、铜、锰、硅、硼、金、银、钒、铊、硒12种微量元素和钙、磷、镁3种常量元素。其中锌、铁、铜、锰,铝5种微量元素及3种常量元素在不同精子密度的各组间的含量无显著性差异(P>0.05)。在不同精子活动力的两组间其精浆锌含量有极显著性差异(P<0.001),说明精浆中高锌可能是维持精子活动力的重要因素之一。精浆中铁及常量元素钙镁的含量与精浆锌含量成正比关系,提示精浆中铁、钙、镁的含量亦可能与精子活动力有关。     

湖北省荆门地区泌尿系结石成分及特征分析

目的探讨湖北省荆门地区的泌尿系结石成分特征,为临床治疗和诊断提供参考。方法选取荆门市第一人民医院、沙洋县人民医院、钟祥市人民医院和京山县人民医院四院泌尿外科于2016年1月至2018年12月间收治的患者资料,将符合标准的2000例患者纳入研究,使用红外光谱法检测其结石成分,并结合患者一般资料进行分析。结果泌尿系结石患者中50~65岁人群患病率最高,为46.60%(932/2000);男性患者1297例(64.85%),为女性患者的1.85倍;其中≤12岁和>75岁患者中的男女比例比值最大,为3∶1。结石主要位于肾脏和输尿管,膀胱占比较少,尿道不常见。结石成分主要草酸钙,其次为碳酸磷灰石和尿酸类,胱氨酸和磷酸铵镁结石不常见;仅在女性患者中发现羟基磷灰石和磷酸氢钙结石(占0.5%~0.7%),同时女性磷酸铵镁成分明显比男性常见(P<0.001)。首发和复发患者结石成分占比大体相似,草酸钙结石占大部分,碳酸磷灰石结石常见,尿酸类和磷酸铵镁结石出现率不高,胱氨酸、羟基磷灰石和磷酸氢钙结石不常见。结论湖北省荆门地区泌尿系结石草酸钙成分和肾脏发病最为常见,男女结石部分成分存在差异,可为该地区临床针对性预防和治疗提供参考。     

Urinary supersaturation with calcium oxalate before and during orthophosphate therapy.

The concentrations of sodium, potassium, calcium, magnesium, phosphorus, sulfate, citrate and oxalate in the urine of normal subjects were compared to the concentrations in urine of calcium oxalate stone-forming patients. Because of the large volume excreted by stone-forming patients the urine contained less concentrations of sodium, potassium, magnesium, phosphorus, sulfate and citrate than did the urine from normal subjects. The urinary concentrations of calcium and oxalate were similar in the 2 groups and, thus, the calculated supersaturation of calcium oxalate was greater in the urine of stone-forming patients than in the urine of normal subjects. Orthophosphate therapy increased the urinary concentration of alkali ions and phosphate but reduced urinary calcium concentration, thereby causing a reduction in urine supersaturation with calcium oxalate. There was no discernible correlation between the phosphate-induced changes in urine supersaturation and the presence or absence of continued calculus formation.     

广金钱草颗粒对结石患者尿液的影响

目的探讨广金钱草颗粒对结石患者尿液尿酸、尿钙、pH值、尿量、草酸钙结晶的影响。方法 20例结石患者,男12例,女8例,平均年龄37岁(20～55岁)。予广金钱草颗粒30 g,口服,2次/d,于服药前及服药后3 d收集患者晨尿及24 h尿,观察治疗前后患者晨尿pH值、尿酸、尿钙、草酸钙结晶及24 h尿量、尿酸、尿钙的变化。结果晨尿尿酸浓度增加(P<0.05),pH值降低(P<0.05),24 h尿量、尿酸、尿钙及晨尿尿钙、草酸钙结晶无明显变化(P>0.05)。结论单味广金钱草颗粒防治结石,需配合其他药物(如碱化尿液),饮水要昼夜兼顾。     

Magnesium-to-calcium ratio in tap water, and its relationship to geological features and the incidence of calcium-containing urinary stones

We examined the relationship among magnesium and calcium content in tap water, the geological features and urinary stone incidence in Japan. The magnesium-to-calcium ratio in tap water correlated negatively with the incidence of urolithiasis. There was no correlation between calcium and magnesium concentration in tap water and urinary stone incidence. Geological features in Japan were classified into 5 groups. The magnesium-to-calcium ratio in the basalt areas was higher than in the other areas, while ratio in the granite areas was low. In the sedimentary rock areas calcium and magnesium concentrations were high; the magnesium-to-calcium ratio in these areas was between those of the basalt and granite areas. The limestone areas had a much higher calcium concentration. The incidence of urinary stones in the sedimentary rock and basalt areas was lower than that of the granite areas, while that in the limestone areas was the highest. Thus, the incidence of urinary stone is related to the magnesium-to-calcium ratio in tap water and the geological area.     

Renal calcium and magnesium handling in water immersion in nephrotic patients

The effect of water immersion to the neck on renal calcium and magnesium handling was studied in 11 nephrotic patients. There was an increase in the urinary excretion of both calcium and magnesium on immersion, and a return towards preimmersion control values in the hour following immersion. Clearances of calcium and magnesium, and fractional excretion of calcium and of magnesium all increased significantly during water immersion, and decreased in the postimmersion hour. However, magnesium excretion was 10-50 times greater than calcium excretion. Fractional excretion of sodium was highly significantly related to fractional excretion of calcium (p less than 0.001) and magnesium (p less than 0.001). The relationship between fractional excretion of phosphate and fractional excretion of calcium was statistically significant (p less than 0.05), as was that between fractional excretion of phosphate and that of magnesium (p less than 0.01). Magnesium and calcium fractional excretions were significantly correlated (p less than 0.01). It was concluded that the increase in calcium and magnesium excretion on immersion is likely to be related to the sodium diuresis caused by central hypervolemia due to immersion.     

Effect of dietary calcium and magnesium on experimental renal tubular deposition of calcium oxalate crystal induced by ethylene glycol administration and its prevention with phytin and citrate

Oral administration of ethylene glycol to rats, and the resultant intratubular depositions of microcrystals of calcium oxalate were studied investigating the influences of dietary calcium or magnesium and assessing the protective efficacies against the crystallizations by treatment with phytin and sodium citrate. With increase of calcium intake and consequent increase of urinary calcium excretion there was a marked increase in the amount of tubular deposit of calcium oxalate crystal and in the calcium content of renal tissue. Although magnesium deficiency accelerated renal tubular calcium oxalate deposition, the protection against the crystal formation was not observed with excessive dietary magnesium. When rats were fed a high-calcium diet supplemented with phytin, a significant inhibition of the intratubular crystallization was observed. It appeared obvious that a hypocalciuric action of phytin was attributed to the effect of the prevention. There was vigorous protection of crystal formation by treatment with sodium citrate, which correlated with the level of citrate concentration in the drinking water.     

Clinical studies of the recurrence of urolithiasis (3). Influence of sodium intake on urinary excretion of calcium, uric acid, oxalate, phosphate and magnesium

Relationship between urinary sodium excretion and urinary excretion of calcium, uric acid, oxalate, phosphate and magnesium was analyzed in 93 ambulatory patients with urolithiasis. There was a significant correlationship between urinary sodium excretion and urinary excretion of calcium, uric acid, oxalate (only in male stone formers), phosphate and magnesium, respectively. Under a salt restricted diet (NaCl 3-5 gm/day) for 3 days, urinary sodium excretion of 16 inpatients with urolithiasis was reduced remarkably together with significant reduction of urinary excretion of calcium, uric acid and oxalate. Urinary excretion of phosphate and magnesium showed no change. From these findings we conclude that restriction of sodium intake is an effective treatment for prevention of stone recurrence.     

佛山市顺德地区原住居民与外来居民尿路结石成分差异性分析

目的分析广东佛山市顺德地区原住居民与外来居民尿路结石成分的差异性。方法选取顺德区新容奇医院泌尿外科2017年1月~2019年1月收治的300例尿路结石患者,根据居民来源分为原住居民组150例及外来居民组150例,利用红外光谱结石检测仪对尿路结石成分进行分析和比对。结果原住居民组含钙结石占比、纯尿酸结石占比高于外来居民组,感染性结石占比低于外来居民组,差异有统计学意义(P0.05),其他结石占比差异无统计学意义(P0.05);原住居民组中一水草酸钙占比高于原住居民组,差异有统计学意义(P0.05),二水草酸钙、一水草酸钙+二水草酸钙尿酸铵、无水尿酸、一水尿酸钠以及二水尿酸占比与外来居民组数值相当,差异无统计学意义(P0.05)。结论顺德地区原住居民与外来居民尿路结石成分存在较大差异性。