三聚氰胺相关尿路结石成分变化的研究及其临床意义。
Study of stone composition changes in melamine-related urinary calculi and its clinical significance.
机构信息
Center Laboratory, Department of Urology, People's Hospital in Gansu Province, Lanzhou, China.
出版信息
Urology. 2011 Aug;78(2):417-20. doi: 10.1016/j.urology.2010.12.060. Epub 2011 Feb 26.
OBJECTIVES
To investigate the composition changes in melamine-related urinary calculi and their clinical significance.
METHODS
A total of 49 melamine-related urinary calculi were included from 49 children (age 4-82 months, mean 22). The qualitative analysis of stone composition was determined using Fourier transform infrared. The quantitative analysis of the stone computed tomography (CT) attenuation value, stone uric acid level, and stone calcium level were measured using spiral CT, high-performance liquid chromatography, and flame atomic absorption spectrum, respectively.
RESULTS
Fourier transform infrared showed that 41 (84%) of the 49 stones contained uric acid and 25 (51%) contained calcium compounds. The data from the qualitative and quantitative analysis were available for 15 stones because of sample consumption in the detection process (Fourier transform infrared, atomic absorption spectrum, and high-performance liquid chromatography). A negative correlation was observed between stone uric acid level and stone calcium level (n = 15, r = -0.629, P = .009). A positive correlation was observed between the stone calcium level and stone CT attenuation value (n = 25, r = 0.855, P = .000). Compared with the ≤1-year-age group and the 1-2-year-age group, the stone calcium level in the >2-year-age group was significantly greater (27.51% ± 12.65% vs 1.60% ± 1.68% or 10.12% ± 8.69%, P = .000 and P = .003, respectively). Compared with the alkalization-alone group, the stone calcium level in the nonalkalization-alone group was significant greater (19.83% ± 7.48% vs 1.25% ± 1.43%, n = 19, P = .000).
CONCLUSIONS
The stones from children >2 years old were not amenable to medical treatment because they contained greater levels of calcium, which can be demonstrated by the radiologic "positive stone image" or stone CT attenuation value. We believe that surgical invention will be the best choice for such patients if extracorporeal shock wave lithotripsy has failed.
目的
研究三聚氰胺相关尿路结石的成分变化及其临床意义。
方法
收集 49 例三聚氰胺相关尿路结石患儿（年龄 4-82 个月，平均 22 个月）的结石标本。采用傅里叶变换红外光谱定性分析结石成分，螺旋 CT 测量结石 CT 值衰减、结石尿酸水平、结石钙水平，采用高效液相色谱法和火焰原子吸收光谱法分别定量分析。
结果
傅里叶变换红外光谱显示 49 例结石中有 41 例（84%）含有尿酸，25 例（51%）含有钙化合物。由于检测过程中样本消耗，仅对 15 例结石的定性和定量分析数据进行了分析（傅里叶变换红外光谱、原子吸收光谱和高效液相色谱）。结石尿酸水平与结石钙水平呈负相关（n = 15，r = -0.629，P =.009）。结石钙水平与结石 CT 值衰减呈正相关（n = 25，r = 0.855，P =.000）。与≤1 岁年龄组和 1-2 岁年龄组相比，>2 岁年龄组的结石钙水平显著更高（27.51%±12.65%比 1.60%±1.68%或 10.12%±8.69%，P =.000 和 P =.003）。与单纯碱化组相比，非单纯碱化组的结石钙水平显著更高（19.83%±7.48%比 1.25%±1.43%，n = 19，P =.000）。
结论
对于>2 岁的患儿结石，由于其钙含量较高，可表现为影像学“阳性结石影”或结石 CT 值衰减，不适合进行药物治疗。如果体外冲击波碎石术失败，我们认为手术是此类患者的最佳选择。
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