Bansal Amar D, Hui Jennifer, Goldfarb David S
Department of Medicine, New York University School of Medicine, New York, New York, USA.
Clin J Am Soc Nephrol. 2009 Mar;4(3):680-4. doi: 10.2215/CJN.05181008. Epub 2009 Mar 4.
Data from several countries suggest a recent world-wide increase in the prevalence of stone disease. However, these studies have not analyzed the effect that increases in utilization of imaging modalities have had on detection of asymptomatic stones.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: A retrospective chart review of all patients who had an abdominal or retroperitoneal ultrasound in 2005 at a Department of Veterans' Affairs Medical Center was conducted. The charts of patients who had ultrasounds demonstrating kidney stones were further reviewed. Patients were classified into symptomatic and asymptomatic groups on the basis of their clinical history. Age and sex for all patients were recorded. For those patients with stones, additional data were recorded. Of all patients in the study, the percentage of those with asymptomatic stones was calculated. Taking into account uncertainty about symptomaticity in some patients, a sensitivity analysis for the presence or absence of gross and microhematuria was performed to determine a range for the percent of asymptomatic stones. Appropriate statistical tests were used to determine significance.
The prevalence of all kidney stones in the study group was 8.6 %. Using the sensitivity analysis, 29.8 to 45.7% of all stones were asymptomatic. Of stones found on abdominal ultrasounds, 71.4% were asymptomatic, whereas 36.8% of stones found on retroperitoneal ultrasound were asymptomatic.
Asymptomatic stones have a relatively high prevalence on ultrasound. Epidemiologic estimates of prevalence of nephrolithiasis need to account for increases in utilization of imaging modalities and the resulting detection bias.
来自多个国家的数据表明，近期全球结石病的患病率有所上升。然而，这些研究并未分析成像方式使用增加对无症状结石检测的影响。
设计、地点、参与者与测量方法：对2005年在一家退伍军人事务医疗中心接受腹部或腹膜后超声检查的所有患者进行回顾性病历审查。对超声检查显示有肾结石的患者病历进行进一步审查。根据患者的临床病史将其分为有症状组和无症状组。记录所有患者的年龄和性别。对于有结石的患者，记录其他数据。计算研究中所有患者中无症状结石患者的百分比。考虑到部分患者症状的不确定性，对肉眼血尿和镜下血尿的有无进行敏感性分析，以确定无症状结石百分比的范围。使用适当的统计检验来确定显著性。
研究组中所有肾结石的患病率为8.6%。通过敏感性分析，所有结石中有29.8%至45.7%为无症状结石。在腹部超声检查中发现的结石，71.4%为无症状结石，而在腹膜后超声检查中发现的结石，36.8%为无症状结石。
无症状结石在超声检查中患病率相对较高。肾结石患病率的流行病学估计需要考虑成像方式使用的增加以及由此产生的检测偏倚。
