[尿石症患者活动性尿路结石形成的最重要因素]

Simić-Ogrizović Sanja, Dopsaj Violeta, Jovicić Svetlana, Milenković Dragica, Jovanović Dijana, Nesić Vidosava

Institut za urologiju i nefrologiju, Klinicki centar Srbije, Beograd.

Med Pregl. 2007;60 Suppl 2:117-20.

INTRODUCTION

Urolithiasis, which affects 1-5% of western world population causing significant morbidity, is heterogeneous disorder with varying pathophysiologic milieu. Patients with recurrent stone formation are the particular problem because the understanding of the risk factors for active stone formation is deficient. The aim of the present study was to determine the most important metabolic and clinical parameters for active stone formation in order to recommend the best preventive therapies.

MATERIALS AND METHODS

In this study 134 consecutive outpatients (57 males, 46.9+/-14.4 years old) were referred and evaluated for urinary stone disease at our Institute. Clinical and metabolic parameters were determined by standardized procedures of questionnaire, serum biochemical profiles and urinalyses. An active stone former group was defined by an increase in the size or number of stones, or a recurrent stone event within 2 years.

RESULTS

In the evaluated cohort, 51 patients (38.1%) created the active stone former group. These patients were younger in the moment of the first stone elimination, had higher serum creatinine concentration, lower urine citrate concentration, as well as citrate/calcium ratio, higher urine pH and more frequently had clinical important urine sediment with eritrocituria and lenkocituria compared to the non-active stone group. Significant positive correlations were found between the active stone former and serum creatine concentration (r=0.227), urine pH (r=0.223), urine sediment (r=0.255) but negative with urine citrate (r=-0.275) and citrate/calcium ratio (r=-0.227). However, multivariate analysis indicated that clinical important urine sediment with eritrocituria and leuokocituria (p=0.033) and low urine citrate (p=0.04) were the only determinants of active urinary stone formation.

CONCLUSION

Further study is required to investigate efficacy of alkaline citrate substitution and rigorous diagnosis and treatment of infections in order to prevent urinary stone recurrence.

引言

尿石症影响着西方世界1%-5%的人口，导致显著的发病率，是一种具有不同病理生理环境的异质性疾病。复发性结石形成的患者是一个特殊问题，因为对活动性结石形成的危险因素了解不足。本研究的目的是确定活动性结石形成最重要的代谢和临床参数，以便推荐最佳预防疗法。

材料与方法

在本研究中，134名连续的门诊患者（57名男性，年龄46.9±14.4岁）被转介到我们研究所进行尿石症评估。通过标准化的问卷程序、血清生化指标和尿液分析来确定临床和代谢参数。活动性结石形成者组定义为结石大小或数量增加，或在2年内发生复发性结石事件。

结果

在评估队列中，51名患者（38.1%）构成了活动性结石形成者组。与非活动性结石组相比，这些患者在首次排石时更年轻，血清肌酐浓度更高，尿枸橼酸盐浓度以及枸橼酸盐/钙比值更低，尿液pH值更高，并且更频繁地出现具有临床意义的尿沉渣，伴有红细胞尿和白细胞尿。在活动性结石形成者与血清肌酸浓度（r=0.227）、尿液pH值（r=0.223）、尿沉渣（r=0.255）之间发现显著正相关，但与尿枸橼酸盐（r=-0.275）和枸橼酸盐/钙比值（r=-0.227）呈负相关。然而，多变量分析表明，具有临床意义的伴有红细胞尿和白细胞尿的尿沉渣（p=0.033）和低尿枸橼酸盐（p=0.04）是活动性尿路结石形成的唯一决定因素。