Pak Charles Y C, Poindexter John R, Adams-Huet Beverley, Pearle Margaret S
Center for Mineral Metabolism and Clinical Research, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8885, USA.
Am J Med. 2003 Jul;115(1):26-32. doi: 10.1016/s0002-9343(03)00201-8.
To determine if kidney stone composition can predict the underlying medical diagnosis, and vice versa.
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.
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.
Stone composition has some predictive value in diagnosing medical conditions, and vice versa, especially for noncalcareous stones.
确定肾结石成分是否能够预测潜在的医学诊断，反之亦然。
我们研究了1392例肾结石患者，这些患者接受了完整的门诊评估，并提交了一块或多块结石进行分析。我们确定了医学诊断与结石成分之间的关联。
最常见的肾结石由草酸钙组成（n = 1041例患者[74.8%]），草酸钙 - 磷酸钙混合结石（n = 485例[34.8%]），以及单纯的磷酸钙结石（n = 146例[10.5%]）。最常见的医学诊断为低枸橼酸尿症（n = 616例患者[44.3%]），吸收性高钙尿症（n = 511例[36.7%]），以及高尿酸尿症（n = 395例[28.4%]）。磷酸钙结石和草酸钙 - 磷酸钙混合结石与肾小管酸中毒和原发性甲状旁腺功能亢进的诊断相关（比值比≥2），但与慢性腹泻综合征无关。随着结石中磷酸盐含量从草酸钙增加到草酸钙 - 磷酸钙混合结石，最后增加到磷酸钙结石，肾小管酸中毒患者的比例从5%（57/1041）增加到39%（57/146），原发性甲状旁腺功能亢进患者的比例从2%（26/1041）增加到10%（14/146）。草酸钙结石与慢性腹泻综合征相关，但与肾小管酸中毒无关。纯尿酸结石和混合尿酸结石与痛风素质密切相关，反之亦然。慢性腹泻综合征与尿酸结石相关，透钙磷石与肾小管酸中毒相关。正如预期的那样，感染性结石与感染之间、胱氨酸结石与胱氨酸尿症之间存在非常强的关联。
结石成分在诊断医学状况方面具有一定的预测价值，反之亦然，尤其是对于非钙质结石。
