瘦猪肉餐对草酸钙结石患者尿生化的影响

目的研究瘦猪肉餐对一水草酸钙（calciumoxalate monohydrate,COM）与二水草酸钙（calciumoxalate dehydrate,COD）结石患者尿生化的影响,探讨草酸钙结石形成的机制。方法正常人、COM与COD结石患者各6例,共18例同予以煮瘦猪肉350g食用,收集实验日晨5-7时2h尿为样本,餐后各留3次2h尿标本,测定尿pH值和尿晶体成分浓度;采用SPSS软件对检测结果进行方差分析。结果三组受试者瘦猪肉餐后尿钙、尿酸和尿草酸排泄逐渐增加,而尿量、尿pH值和尿枸橼酸降低;瘦肉餐前后比较,COM与COD结石患者尿pH值、尿枸橼酸、尿钙和尿草酸有显著性差异（P〈0.05）,尿酸排泄有极显著性差异（P〈0.01）;对照组,尿钙、尿酸排泄均有显著性差异（P〈0.05,P〈0.01）。结论大量饮食猪瘦肉可导致尿pH值和尿晶体成分变化,可能是尿结石形成的重要原因之一。     

高效液相色谱法测定尿液中有机酸含量的方法学评价及临床应用

目的：建立高效液相色谱法（high performance liquid chromatography,HPLC）测定尿液中有机酸含量的方法学并应用于临床。方法：应用HPLC技术分析健康人及尿结石患者尿液中草酸和枸橼酸的含量。色谱条件：色谱柱LC-C18（250mm×4．6mm,5um）,保护柱LC-C18（4．6mm×12．5mm,5um）。流动相为0．25％磷酸二氢钾（含2．5mmol／L四丁基磷酸氢铵和2．65×10^-5mol／L二乙胺四乙酸二钠,pH2．0）,检测波长210nm,流速1．0ml／min,柱温25℃,进样量20ul。选择上述色谱条件计算曲线下面积测定草酸和枸橼酸含量。结果：草酸与枸橼酸的标准曲线分别为Aoxa=12528．4Coxa-641．9（r=0．9990,n=5）和Acit=1607．5Ccit-13．8（r=0．9990,n=5）;最低检测限分别为0．4ug／ml和0．8ug／ml;线性范围分别为1．563～100ug／ml和3．125～200ug／ml;平均回收率分别为96．6％和95．7％;日内及日间精密度分别小于13．5％和8．3％。二水草酸钙组的尿草酸高于-水草酸钙组和对照组（P〈0．05）,一水草酸钙组的尿枸橼酸低于二水草酸钙组和对照组（P〈0．05）。结论：HPLC用于检测人24h尿液中的草酸和枸橼酸方法简单。一水草酸钙结石的形成与结石抑制物枸橼酸的缺乏有关,二水草酸钙结石的形成与高尿草酸有关。     

一水草酸钙与二水草酸钙结石形成机理的研究

目的　探讨一水草酸钙（ＣＯＭ） 与二水草酸钙（ＣＯＤ） 结石形成的机制。　方法　应用红外光谱仪对２５８ 块尿结石成分进行检测,同时检测３０ 例患者２４ｈ 尿液生化指标,对测定结果利用ＳＰＳＳ软件进行ｔ 检验。　结果　（１） 尿钙：ＣＯＭ 组（４．８３ ±１ ．９８）ｍ ｍｏｌ／２４ｈ,ＣＯＤ 组（９．８８ ±４ ．２８）ｍｍｏｌ／２４ｈ,Ｐ＜ ０ ．０１ ;（２） 尿磷：ＣＯＭ 组（１９ ．４０ ±９．６９）ｍ ｍｏｌ／２４ｈ,ＣＯＤ 组（２９．２０ ±１２．００）ｍ ｍｏｌ／２４ｈ,Ｐ＜ ０．０５,两组尿钙、尿磷差异有显著性。　结论　二水草酸钙结石患者尿钙、尿磷高于一水草酸钙结石患者,表明二水草酸钙的形成与高钙尿及磷酸盐异质成核有关,而一水草酸钙的形成可能与尿中抑制物缺乏有关。     

上海市浦东新区泌尿系结石患者与健康体检者结石相关因素的对照研究

目的：探讨泌尿系结石患者与健康体检者结石相关因素。方法：对300例泌尿系结石患者的结石成分进行分析,并结合血生化及24h尿液分析结果,与300例健康体检者进行对照研究。结果：尿石症患者中,草酸钙结石232例（77．3％）,磷酸盐结石50例（16．7％）,感染性结石9例（3％）,尿酸结石9例（3％）。结石患者血清镁、钙、磷及24h尿氯、钙、镁、磷、尿酸显著高于健康体检者（P〈0．05）,而血钾、尿枸橼酸则显著低于健康体检者（P〈0．05）。结论：尿结石与多种代谢异常关系密切,结石成分及代谢评估对泌尿系结石的成因、治疗和预防有重要临床指导意义。     

泌尿系结石儿童患者24h尿液成石危险因素分析

目的:分析泌尿系结石儿童患者24h尿液成石危险因素的特点。方法:回顾性分析广州医科大学附属第一医院泌尿外科2004年1月至2013年12月泌尿系结石儿童患者(年龄0~18周岁)的24h尿液成石危险因素分析结果,包括尿量,尿钙,尿镁,尿钠,尿尿酸,尿磷,尿胱氨酸,尿草酸和尿枸橼酸等因素。结果:24h尿液成石危险因素分析结果显示,80名泌尿系结石儿童患者中仅2.5%未合并尿液代谢异常,其中97.5%有低枸橼酸尿症,50.0%有高钠尿症,48.7%有胱氨酸尿症,18.8%有高钙尿症,12.5%少尿,11.3%有低镁尿症,5.0%有高草酸尿症,1.3%有高尿酸尿症。此外,女性患儿的尿量明显多于男性患儿[(73.2±58.5)ml/kg vs.(51.3±45.3)ml/kg,P0.05],年长患儿(9~18岁)的尿钠及尿草酸排泄量高于年幼患儿(0~9岁)[尿钠:(5.24±3.25)mmol/kg vs.(3.32±2.23)mmol/kg;尿草酸:(0.014±0.016)mmol/kg vs.(0.008±0.007)mmol/kg],差异均有统计学意义(P0.05)。结论:泌尿系结石儿童患者24h尿液成石危险因素存在明显异常,其中低枸橼酸尿症是最常见的尿液代谢异常,而胱氨酸尿症的高发病率需要进一步重视。     

24h尿枸橼酸定量分析在尿石症患者诊治中的意义

目的对30例含钙尿石症患者24h尿枸橼酸排泄进行了病例对照研究,旨在从病因学角度对尿石症的影响因素进行探讨,为临床诊治提供依据。方珐测定30例尿石症患者和30例正常人的24h尿枸橼酸和钙的含量,比较两组的差异;并比较低枸橼酸尿症与高钙尿症与尿石症发病的相关性。结果24h尿枸橼酸的排泄量在结石患者为（224．26±147．63）mg,显著低于正常人（434．58土280．89）mg,且性别差异具有显著性意义,男性低于女性（P〈0．05）。结石患者24h尿液中的枸橼酸／钙比值明显高于正常人（P〈0．05）。低枸橼酸尿症与尿石症发病的相关性高于高钙尿症（P〈0．05）。结论女性24h尿枸橼酸排泄量约为男性的1．4～1．6倍,建议对尿石症患者的代谢评估应考虑性别差异。在结石的代谢评估中,按照性别分类的24h尿枸橼酸／钙比值的降低可能比单纯尿枸橼酸降低更有意义。低枸橼酸尿症在尿石症的代谢评估中可能是比高钙尿症更加重要的指标。     

尿钙水平对草酸钙结石患者尿液MCP-1和MDA生成的影响

目的：探讨尿钙水平在结石形成过程中的作用。方法：选择草酸钙结石住院患者110例,按尿钙水平分为两组,24小时尿钙≥240mg／d的35例纳入高尿钙结石组,24小时尿钙％240mg／d的75例纳入低尿钙结石组;同时随机挑选30例无泌尿系结石的健康者作对照组。收集三组尿液,分别运用ELLISA和TBA法检测尿液中细胞因子MCP—1、TGF—β和脂质过氧化产物丙二醛（MDA）的含量。结果：MCPl在高尿钙组、低钙尿组和健康对照组问的含量分别为36．7（23．71,50．22）pg／ml、29．22（20．40,40．29）pg／ml、26．98（13．59,38．60）pg／ml;与其他两组比较,高尿钙组尿液中MCP1生成增多（P〈0．05）。TGF-β在三组间含量无差别（P〉0．05）。MDA在高尿钙组、低钙尿组和健康对照组问的含量分别为2．02（1．05,2．95）nmol／ml、1．70（1．00,2．18）nmol／ml、1.19（0．73,1．41）nmol／ml;与健康对照组比较．高尿钙结石组和低尿钙结石组尿中MDA生成增加（P〈0．05）;高尿钙结石组和低尿钙结石组尿巾MDA则无明显差异（P〉0．05）。相关性分析,尿钙水平与尿MCP—1水平存在iESH关关系,r=0．226,P〈0．05;尿钙水平与MDA水平无明显相天关系（P〉0．05）。结论：高尿钙可促进草酸钙结石患者尿液MCP-1生成增多,TGF-β的生成无明显变化。草酸钙结石患者尿液MDA水平升高,提示肾脏氧化应激水平增加,但高尿钙并未影响患者尿MDA的生成水平,提示高尿钙在草酸钙结石患者肾脏氧化应激损伤中不越丰耍的作用．     

尿石成分与血尿理化性质的关系

目的探讨本地区不同成分的结石与血尿理化性质之间的关系。方法对645例泌尿系结石成分进行分析,其中284例获取完整的24h尿液分析及血电解质的结果,与对照组进行比较。结果645例结石中以混合性结石占多数,其中以草酸钙为主。4种结石类型结石患者的24h尿量均显著低于对照组（P〈O．01）;尿酸为主结石组尿pH值明显低于其他类型结石组及对照组（P〈O．01）;草酸盐为主结石组的尿钙排泄及高尿钙病例数明显高于其他类型结石组及对照组（P〈O．01）。各组间及对照组之间血钾、钠、钙、磷、镁及氯无差异。结论结石成分与尿液理化性质之间有着密切关系。24h尿量、尿pH及高尿钙会对相应成分的结石产生影响,对于各种成分结石治疗与预防具有积极的临床意义。     

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。     

TRPV5与特发性高钙尿症的研究进展

特发性高钙尿症（IdiopathicHypercalciuria，IH）为一种常见的多因素、多系统参与的受遗传、环境、饮食影响的钙代谢紊乱，是指排除各种已知疾病，24h尿钙排泄量〉0．1mmol／kg或者男性≥7．5mmol、女性≥6．25mmol。它是泌尿系结石形成的最危险因素。尿石的形成是由多因素引起的，目前的泌尿系结石约有80％以上为含钙结石，而对于钙性结石，其中40％-50％是由高钙尿引起的。     

Stone composition and metabolic status

This paper aims to study the correlation between biochemical risk factors of the stone former and the type of oxalate stone formed, namely calcium oxalate monohydrate (COM) and calcium oxalate dehydrate (COD). A retrospective study of 487 patients who had been attending the urinary stone clinic, Trivandrum during 1998–2007 was conducted. The stones retrieved from them were subjected to chemical analysis and FTIR spectrographic analysis. They were categorized into COM, COD, mixed COM+COD and others. Of 142 pure calcium oxalate stone patients, 87 were predominantly COM stone formers and 55 COD stone formers. Their metabolic status of 24 h urine and serum was assessed. The values of urine calcium, phosphorus, uric acid, magnesium, creatinine, oxalate, citric acid, sodium and potassium, serum values of calcium, phosphorus, uric acid, magnesium and creatinine and calculated values of creatinine clearance, tubular reabsorption of phosphate, calcium magnesium ratio and calcium oxalate ratio were recorded. Comparison was made between the COM stone group and the COD stone group. Patients forming COM stones had significantly higher mean values for urine calcium (P < 0.05), oxalate (P < 0.01) and magnesium (P < 0.05) levels and significantly lower level of urine calcium–oxalate ratio (P < 0.01) and urine calcium–magnesium ratio (P < 0.01) compared to COD stone forming patients. All other values failed to show significant difference. Patients, with higher urine oxalate, formed COM stones. Those with low magnesium (which is an inhibitor) formed more of COD stones. Urine calcium was high in both groups without showing significant variation from the mean. In patients with high calcium–oxalate and calcium–magnesium ratios, there is higher chance of forming a COD stone than COM. Identification of the crystallization pattern of the calcium stone will help in selecting treatment modalities.     

Comparison of renal function and metabolic abnormalities of cystine stone patients and calcium oxalate stone patients in China

Purpose

To compare renal function and metabolic abnormalities of cystine stone patients and calcium oxalate stone patients in China.

Methods

Between 2008 and 2011, thirty cystine stone patients were involved in our study, and an equal number of age- and gender pair-matched patients with calcium oxalate stones. Non-stone forming individuals were elected as controls. The evaluation included blood chemistry studies and 24-h urine collection in both groups of patients.

Results

The cystine stone patients had higher mean values of serum blood urea nitrogen, urate and creatinine levels than patients in other two groups. With respect to urine risk factors, cystine stone patients had higher urinary citrate and lower urinary oxalate and creatinine than calcium oxalate stone patients. When compared to non-stone forming individuals, cystine stone patients had higher urinary urate excretion and lower urinary creatinine excretion. Metabolic abnormalities could be demonstrated in 80 % of the cystine stone patients and in 100 % of the calcium oxalate stone patients. We also compared urine risk factors among cystine stone patients with different urine cystine excretion (<1 mmol/24 h, 1–2 mmol/24 h and >2 mmol/24 h). No significant difference was found in urine risk factors among three groups.

Conclusions

This study suggested that cystine stone patients were at greater risk for the loss of renal function than calcium oxalate stone patients, but the risk of the formation of calcium oxalate stones was lower. Our results also indicated that urinary cystine had little or no impact on the excretion of urine chemistries in cystine stone patients.     

Cooperation of phosphates and carboxylates controls calcium oxalate crystallization in ultrafiltered urine

Osteopontin (OPN) is one of a group of proteins found in urine that are believed to limit the formation of kidney stones. In the present study, we investigate the roles of phosphate and carboxylate groups in the OPN-mediated modulation of calcium oxalate (CaOx), the principal mineral phase found in kidney stones. To this end, crystallization was induced by addition of CaOx solution to ultrafiltered human urine containing either human kidney OPN (kOPN; 7 consecutive carboxylates, 8 phosphates) or synthesized peptides corresponding to residues 65–80 (pSHDHMDDDDDDDDDGD; pOPAR) or 220–235 (pSHEpSTEQSDAIDpSAEK; P3) of rat bone OPN. Sequence 65–80 was also synthesized without the phosphate group (OPAR). Effects on calcium oxalate monohydrate (COM) and dihydrate (COD) formation were studied by scanning electron microscopy. We found that controls form large, partly intergrown COM platelets; COD was never observed. Adding any of the polyelectrolytes was sufficient to prevent intergrowth of COM platelets entirely, inhibiting formation of these platelets strongly, and inducing formation of the COD phase. Strongest effects on COM formation were found for pOPAR and OPAR followed by kOPN and then P3, showing that acidity and hydrophilicity are crucial in polyelectrolyte-affected COM crystallization. At higher concentrations, OPAR also inhibited COD formation, while P3, kOPN and, in particular, pOPAR promoted COD, a difference explainable by the variations of carboxylate and phosphate groups present in the molecules. Thus, we conclude that carboxylate groups play a primary role in inhibiting COM formation, but phosphate and carboxylate groups are both important in initiating and promoting COD formation.     

The role of hyperoxaluria in the formation of calcium oxalate urinary calculi, and its association with other biochemical measurements

The part played by hyperoxaluria in the formation of calcium oxalate urinary calculi was studied in 153 patients who had each been diagnosed as having calcium oxalate urinary calculi on one or more occasions. Seventy-seven of the patients excreted normal amounts of calcium (less than 6.2 mmol/d), and 76 had hypercalciuria (excretion greater than or equal to 6.2 mmol/d); each group was divided into a further two groups depending on whether the oxalate concentration was above or below 0.16 mmol/l. Pure calcium oxalate stones were more common in patients whose calcium excretion was normal, and mixed calcium oxalate and phosphate stones were more common among hypercalciuric patients. Urinary concentrations/day of magnesium, citrate, and phosphorus were significantly lower in the two groups in which the oxalate concentrations were below 0.16 mmol/l than in a normal control group, and magnesium and phosphorus were significantly lower in the two groups in which oxalate concentrations were less than 0.16 mmol/l than in the two in which they were above that value. The concentration of citrate was also lower, but not significantly so. In addition, the pH of the urine in patients with mixed stones was significantly higher in all groups than when the stones were composed of pure calcium oxalate.     

Low urine citrate excretion as main risk factor for recurrent calcium oxalate nephrolithiasis in males.

To better define the relative role of metabolic factors in the recurrence of stone formation, we studied the 24-hour urinary excretion of calcium (uCa), citrate (uCit), oxalic acid (uOx) and uric acid (uUa) in 73 male patients with primary calcium oxalate urolithiasis. According to the episodes of stone formation per year, we identified 51 recurrent stone formers (RSF) and 22 single stone formers (SSF). 20 normal adult males constituted the control group (C). uCa and uOx were higher in RSF than in C, but quite similar in SSF and RSF. The only difference between RSF and SSF was uCit, significantly lower (2.06 +/- 1.04 mmol/24 h) in RSF than in SSF (3.22 +/- 1.18 mmol/24 h, p less than 0.001) and in C (3.42 +/- 1.33 mmol/24 h, p less than 0.001). Hypocitraturia (uCit less than 1.5 mmol/24 h) was found in 16 of 51 RSF (31.4%) and in 1 of 22 SSF (4.5%). These data confirm that high levels of uCa and uOx represent a risk factor for lithogenesis, but also strongly indicate the low uCit excretion as the most important urinary abnormality accounting for the recurrence of calcium oxalate stones.