brushite 结石形成者特征。
Profile of the brushite stone former.
机构信息
Methodist Hospital Institute for Kidney Stone Disease, Indianapolis, Indiana 46202, USA.
出版信息
J Urol. 2010 Oct;184(4):1367-71. doi: 10.1016/j.juro.2010.05.094. Epub 2010 Aug 17.
PURPOSE
The incidence of brushite stones has increased during the last 3 decades and we report our experience with brushite stone formers.
MATERIALS AND METHODS
From 1996 to 2008 we identified 82 patients with brushite urinary calculi. After institutional review board approval a review of our prospectively collected database was performed.
RESULTS
There were 54 (65.9%) male and 28 (34.1%) female stone formers. Mean age was 44 years (range 4 to 84). Prior stone events were reported by 69 (84.1%) patients with 54 (78.3%) having received shock wave lithotripsy. Bilateral calculi were present in 28 (34.1%) patients. Mean stone area was 29.2 mm(2) (range 2 to 130). Surgery was performed in 80 patients including 63 (76.8%) percutaneous nephrolithotomy, 8 (9.8%) ureteroscopy, 3 (3.7%) shock wave lithotripsy, and 6 (7.3%) ureteroscopy and percutaneous nephrolithotomy. After primary and secondary procedures 76 (92.7%) patients were rendered stone-free. Metabolic urine studies were available in 45 patients. All patients demonstrated 1 or more abnormalities, with hypercalciuria (greater than 250 mg daily for women and greater than 275 mg daily for men) in 38 (80.9%), urine pH greater than 6.2 in 29 (61.7%), urine volume less than 2 l in 27 (57.4%), hypocitraturia (less than 320 mg daily) in 22 (46.8%), hyperuricosuria (greater than 750 mg daily in women, greater than 800 mg daily in men) in 8 (17%) and hyperoxaluria (greater than 32 mg daily in women and greater than 43 mg daily in men) in 5 (10.6%). Recurrent stone events occurred in 31 (37.8%) patients at a mean of 33 (range 2 to 118) months from treatment.
CONCLUSIONS
Brushite stone formers are a treatment challenge. Almost a third will present with bilateral stones and the stone burden is sizeable. Nearly 80% of patients report having prior shock wave lithotripsy and recurrent stone events occurred approximately 3 years after treatment. All patients with brushite stones in this cohort had an underlying metabolic abnormality and specifically brushite stones should be heralded as a marker for hypercalciuria. Based on these data we recommend all brushite stone formers undergo 24-hour urine studies and have close long-term followup.
目的
过去 30 年来，鸟粪石结石的发病率有所增加，我们报告了鸟粪石结石患者的经验。
材料和方法
从 1996 年到 2008 年，我们确定了 82 例鸟粪石尿结石患者。在获得机构审查委员会批准后，我们对前瞻性收集的数据库进行了回顾。
结果
54 例（65.9%）为男性，28 例（34.1%）为女性。平均年龄为 44 岁（范围 4 至 84 岁）。69 例（84.1%）患者有既往结石事件，54 例（78.3%）接受过体外冲击波碎石术。28 例（34.1%）患者存在双侧结石。平均结石面积为 29.2mm²（范围 2 至 130）。80 例患者接受了手术治疗，包括 63 例经皮肾镜取石术（PCNL）、8 例输尿管镜检查术、3 例体外冲击波碎石术和 6 例输尿管镜检查术联合 PCNL。初次和二次手术后，76 例（92.7%）患者结石清除。45 例患者进行了代谢性尿液研究。所有患者均有 1 种或多种异常，38 例（80.9%）存在高钙尿症（女性大于 250mg/天，男性大于 275mg/天），29 例（61.7%）尿液 pH 值大于 6.2，27 例（57.4%）尿液量小于 2L，22 例（46.8%）尿枸橼酸盐浓度降低（女性小于 320mg/天，男性小于 320mg/天），8 例（17%）存在高尿酸尿症（女性大于 750mg/天，男性大于 800mg/天），5 例（10.6%）存在高草酸尿症（女性大于 32mg/天，男性大于 43mg/天）。31 例（37.8%）患者在治疗后 33 个月（范围 2 至 118 个月）时出现复发性结石事件。
结论
鸟粪石结石患者的治疗具有挑战性。近三分之一的患者会出现双侧结石，结石负荷较大。近 80%的患者报告曾接受过体外冲击波碎石术，复发性结石事件约在治疗后 3 年发生。该队列中所有鸟粪石结石患者均存在潜在代谢异常，具体而言，鸟粪石结石应作为高钙尿症的标志物。基于这些数据，我们建议所有鸟粪石结石患者进行 24 小时尿液检查，并进行密切的长期随访。
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