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。     

痛风及高尿酸患者易患尿路结石机制

痛风和高尿酸血症患者是尿路结石的高发人群。现有的结石治疗方法难以解决结石反复复发的难题,为充分改善患者生活质量,在结石形成之前对可控的危险因素进行控制十分必要。尿酸和草酸钙结石是最常见的结石类型,痛风和高尿酸血症患者尿pH、尿酸排泄量及尿量对这两种结石的形成起到复杂的影响,本文对痛风及高尿酸血症患者易患结石的机制进行综述,以指导临床诊治,减少结石的形成风险。     

代谢综合征患者尿路结石危险因素分析

目的 分析代谢综合征(MS)患者合并尿路结石的特点,试图找到MS患者罹患尿路结石的相关危险因素.方法 选取MS合并尿路结石患者85例,MS排除结石患者80例作为对照组.测定两组人群血清同型半胱氨酸(Hcy)、血尿酸(SUA)、24小时尿酸(aliA)、空腹和餐后2小时血糖、胰岛素、24小时尿微量自蛋白(TUP)等.以上危险因素为自变量,有无尿路结石为应变量做Logistic多元逐步回归.结果 TUA、SUA、胰岛素抵抗指数、Hcy、TUP进入回归模型(R2＝0.823,P＝0.002).结论 高尿酸排泄、血尿酸水平增高、胰岛素抵抗、血Hcy增高等是MS患者罹患尿路结石的危险因素;降低血尿酸水平、改善胰岛素抵抗对于减少MS尿路结石的发生具有重要意义.     

小儿上尿路结石60例临床分析

1991年10月-2006年2月，我们共收治泌尿系结石6248例，其中小儿上尿路结石60例。现报告如下并分析其临床特点。     

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。     

ESWL治疗尿路结石131例分析

我们使用国产B超定位BD8828型干式体外震波碎石机(ESWL)治疗尿路结石131例,效果满意。一、临床资料男113例,女18例,年龄6～75岁。肾结石81例,输尿管结石38例,膀胱结石5例,后尿道结石7例,其中复杂性结石59例。结     

三金汤治疗上尿路结石40例

目的在中医理论指导下，运用中药汤剂观察治疗上尿路结石临床疗效。方法用中药三金汤加味，口服治疗上尿路结石40例。结果临床治愈15例，显效23例，无效2例。总有效率95％。结论中医药治疗上尿路结石疗效确切。     

双J管在上尿路结石ESWL中的应用

1999年 2月～ 2 0 0 1年 2月 ,我们对 34例输尿管结石长期梗阻致肾功能严重受损患者 ,行双 J管内引流后进行(ESWL )治疗。现报告如下。一般资料 :本组男 2 5例 ,女 9例 ;年龄 2 9～ 43岁 ,平均 32岁。结石直径 1～ 1.8cm ,平均 1.6 cm。 16例输尿管下段结石 ,梗阻 2个月～ 1年 ,平均 5个月 ;11例输尿管中段结石 ,梗阻3～ 7个月 ,平均 4.5个月 ;7例输尿管上段结石 ,梗阻 2～ 5个月 ,平均 3个月。行大剂量静脉肾盂造影 (IVU)检查 ,34例患肾功能明显受损 ,其中 2 9例显影延迟 2～ 5小时 ;5例不显影。本组患者行 IVU检查后 ,经膀胱向肾盂内…     

老年人上尿路结石经皮取石术的疗效观察

目的 观察微创经皮肾取石术治疗老年人上尿路结石的安全性和疗效.方法 回顾性总结2004年1月至2006年6月,在我科接受微创经皮肾取石术治疗的144例年龄≥65岁的上尿路结石患者的临床资料. 结果 118例采用椎管内麻醉,26例采用气管内全麻.俯卧位手术133例,仰侧卧位手术11例.24例因手术时间长、出血严重影响视野等情况及时终止手术并采用单侧分期手术.手术时间18～197 min,平均68 min.住院时间8～21 d,平均11 d.出院前复查结石清除率为82.6%(119/144).有3例(2.1%)肾结石患者因出血较多,均输血400 ml,其中1例行介入栓塞治愈.术后感染引起体温38.5℃以上者31例(21.5%).术后手术部位疼痛需镇痛处理者27例(18.8%).术后肾功能持续下降者1例.结论 经充分的术前准备、合理选择分期手术、恰当的术后处理,微创经皮肾取石术是安全、效果确切的治疗老年上尿路结石的手术方法.     

ESWL治疗老年人上尿路结石180例临床分析

应用国产 JT—ESWL Ⅱ型碎石机治疗老年人上尿路结石180例,经多次行 ESWL 及辅以泌尿腔内技术处理成功率100％。随访3个月,碎石排净率肾结石为70％,输尿管结石为83％。与中、青年病例组比较,碎石排净率低。并发症中有出现心律紊乱及输尿管梗阻,梗阻后无症状性肾感染的特点。本文探讨了这些临床现象及处理措施。     

Stone Composition as a Function of Age and Sex

Background and objectives

Kidney stones are heterogeneous but often grouped together. The potential effects of patient demographics and calendar month (season) on stone composition are not widely appreciated.

Design, setting, participants, & measurements

The first stone submitted by patients for analysis to the Mayo Clinic Metals Laboratory during 2010 was studied (n=43,545). Stones were classified in the following order: any struvite, any cystine, any uric acid, any brushite, majority (≥50%) calcium oxalate, or majority (≥50%) hydroxyapatite.

Results

Calcium oxalate (67%) was the most common followed by hydroxyapatite (16%), uric acid (8%), struvite (3%), brushite (0.9%), and cystine (0.35%). Men accounted for more stone submissions (58%) than women. However, women submitted more stones than men between the ages of 10–19 (63%) and 20–29 (62%) years. Women submitted the majority of hydroxyapatite (65%) and struvite (65%) stones, whereas men submitted the majority of calcium oxalate (64%) and uric acid (72%) stones (P<0.001). Although calcium oxalate stones were the most common type of stone overall, hydroxyapatite stones were the second most common before age 55 years, whereas uric acid stones were the second most common after age 55 years. More calcium oxalate and uric acid stones were submitted in the summer months (July and August; P<0.001), whereas the season did not influence other stone types.

Conclusions

It is well known that calcium oxalate stones are the most common stone type. However, age and sex have a marked influence on the type of stone formed. The higher number of stones submitted by women compared with men between the ages of 10 and 29 years old and the change in composition among the elderly favoring uric acid have not been widely appreciated. These data also suggest increases in stone risk during the summer, although this is restricted to calcium oxalate and uric acid stones.     

Risk factors for urinary infection after retrograde upper urinary lithotripsy: Implication for nursing

There are needs to evaluate the risk factors for urinary infection after retrograde upper urinary lithotripsy, to provide insights into the management and nursing care of patients with retrograde upper urinary lithotripsy.Patients who received retrograde upper urinary lithotripsy with a Foley 20 urinary tube insertion from June 1, 2019 to December 31, 2020 in our hospital were selected. Patients were grouped urinary infection and no infection group according to the culture results of urine, and the clinical data of the 2 groups of patients were collected and compared. Single factor and logistic regression analysis were used to analyze the risk factors of urinary tract infection after retrograde upper urinary lithotripsy.Four hundred ten patients with retrograde upper urinary lithotripsy were included, of whom 62 patients had the urinary tract infection, the incidence of urinary tract infection was 15.12%. There were significant differences in the gender, age, diabetes, stone diameter, duration of urinary tube insertion and duration of surgery between infection and no-infection group (all P < .05). The Escherichia coli (62.90%) was the most commonly seen bacterial in patients with urinary tract infection. Female (odds ratio [OR]: 1.602, 95% confidence interval 95% [CI]: 1.132∼2.472), age >50 years (OR: 2.247, 95% CI: 1.346∼3.244), diabetes (OR: 2.228, 95% CI: 1.033∼3.451), stone diameter ≥2 cm (OR: 2.152, 95% CI: 1.395∼3.099), duration of urinary tube insertion ≥3 days (OR: 1.942, 95% CI:1.158∼2.632), duration of surgery ≥90 minutes (OR: 2.128, 95% CI: 1.104∼3.846) were the independent risk factors for the postoperative urinary tract infection in patients with retrograde upper urinary lithotripsy (all P < .05).The incidence of urinary tract infection in patients undergoing retrograde upper urinary lithotripsy was high, counteractive measures targeted on those risk factors are needed to prevent and reduce the postoperative urinary infection in clinical settings.     

Pathogenesis, pathophysiology, and classification

In this article, we discuss kidney stones from the perspectives of the factors that produce excessive urinary supersaturation of the stone-forming elements that comprise clinical calcium (oxalate and phosphate), uric acid, struvite, cystine, or drug stones. These factors include low urine volume, hypercalciuria, hyperoxaluria, hypocitraturia, hyperuricosuria, the presence of bacterial urease, cystinuria, the effects of urine pH, excessive phosphaturia, and the excessive excretion of drugs or metabolites. We describe the various locations of stones throughout the urinary tract and discuss their development from initial single crystal formation and attachment through the clinically appreciable stone. In particular, we present the major competing hypotheses of stone initiation: intratubular crystallization and attachment vs interstitial formation of Randall's plaques. Finally, we discuss in some depth the role of various urine macromolecules, osteopontin, Tamm-Horsfall protein, urninary prothrombin fragment 1, and serum inter-α-inhibitor, as modulators of crystallization processes and stone formation.     

Medical management

Kidney stones are the result of a complex interaction of hereditary and environmental factors. They are an increasingly common affliction of industrialized societies. In nearly all cases, kidney stone formation can be drastically reduced or prevented if the patient adheres closely to a carefully designed prevention program. We emphasize an approach oriented around stone composition and targeted at specific risk factors. Our approach begins with fluid and dietary modifications and progresses to pharmacological treatment in nonresponders.     

血清尿酸水平变化在急性脑梗死患者尿激酶溶栓治疗中的临床意义

目的探讨急性脑梗死患者溶栓治疗前后血清尿酸水平变化及意义。方法选择急性脑梗死患者59例,均进行尿激酶治疗,根据治疗效果分为好转组36例和无好转组23例。检测2组溶栓前、溶栓第2、7天及发病3个月后血清尿酸水平。结果与无好转组比较,好转组溶栓第2天尿酸水平明显下降,差异有统计学意义(P<0.05).2组溶栓治疗前及溶栓第7天以及3个月后尿酸水平比较,差异无统计学意义(P>0.05)。结论尿酸有可能在缺血再灌注过程中发挥一定作用,存在溶栓后尿酸水平衰减。     

尿氟在地方性氟中毒防治中的意义

尿氟指标常常应用于地方性氟中毒的防治和监测工作中，尿氟含量可以反映环境氟暴露水平和人体氟摄入状况，个体尿氟变异较大，对于氟中毒的诊断价值不大，而群体尿尿在氟中毒病区与非病区之间以及不同程度区之间往往有显著性差异，可以作为地方性氟中毒病区判定及防治效果评价的一个有意义指标，在地氟病防治工作中应研制基于人群水平的尿氟正常值。     

血清尿酸检测在肝硬化中的意义

探讨肝硬化患者血尿酸（UA）水平的变化及其意义。对223例乙型肝炎肝硬化患者和106例正常对照者进行血UA检测。结果显示,肝硬化患者组血UA水平明显低于正常对照组（t=2.80,P〈0.01）;肝硬化失代偿组UA水平较肝硬化代偿组降低更为明显。肝硬化伴有肾功能损害时UA水平明显高于正常对照组（t=4.28,P〈0.001）。肝硬化失代偿者UA降低比率（39.6%）明显高于肝硬化代偿者降低比率（25.0%,x2=4.18,P〈0.05）。肝硬化患者血UA水平与前白蛋白（PA）水平呈正相关（r=0.2704,P〈0.01）。研究表明,肾功能正常的肝硬化患者血UA水平降低,其降低程度与病变严重程度密切相关,检测UA对判断肝硬化患者病情、转归及预后有一定的价值。     

冠心病患者尿酸浓度变化的临床意义

目的:通过对冠心病患者的尿酸水平进行监测,阐明尿酸作为冠心病危险因素的价值。方法:于冠状动脉造影证实的冠心病患者79例(男39例,女40例);正常对照组61例(男26例,女35例),测定其总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C),脂蛋白a[LP(a)]及尿酸水平。结果:冠心病患者TC、TG、LDL-C、HDL-C水平与对照组无明显差异,LP(a)、尿酸水平较对照组明显升高(P<0.05),患者冠状动脉病变范围越大、程度越严重,其血浆尿酸和LP(a)水平越高。结论:血浆尿酸合并LP(a)水平升高与冠心病有关。     

Coexistence of hyper-uricaemia and low urinary uric acid excretion further increases risk of chronic kidney disease in type 2 diabetes

AimTo investigate whether hyper-uricaemia and decreased urinary uric acid excretion (UUAE) are associated with increased risk of chronic kidney disease (CKD), and whether the coexistence of hyper-uricaemia and low UUAE further increases CKD risk in type 2 diabetes mellitus (T2DM).MethodsIn this cross-sectional study based on serum uric acid (SUA) and UUAE levels, 2846 T2DM inpatients were divided into those with normal SUA and UUAE (group 1), normal SUA and low UUAE (group 2), hyper-uricaemia and normal UUAE (group 3), and hyper-uricaemia and low UUAE (group 4). Hyper-uricaemia was defined as SUA levels ≥ 420 μmol/L in men and ≥ 360 μmol/L in women. Low UUAE was defined as levels below the first UUAE quintiles (< 2161 μmol/24 h in men, 1977 μmol/24 h in women).ResultsThere were trends for significantly increased prevalences of CKD (4.3%, 12.6%, 18.3%, 47.8%; P < 0.001), albuminuria (20.2%, 26.4%, 36.9%, 54.9%; P < 0.001) and macroalbuminuria (3.3%, 10.1%, 10.7%, 31.9%; P < 0.001) from groups 1 to 4, respectively. After controlling for multiple confounding factors, prevalences of CKD (P < 0.001) and urinary albumin levels (P = 0.013) showed significantly increasing trends, whereas eGFR levels were markedly decreased from groups 1 to 4 (P < 0.001).ConclusionHyper-uricaemia and low UUAE levels are closely associated with presence of CKD, and the concomitant presence of hyper-uricaemia and decreased UUAE levels further increased CKD risk in T2DM. Thus, the combined consideration of SUA and UUAE levels may help to identify those T2DM patients at higher CKD risk.