Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
J Urol. 2013 Apr;189(4):1334-9. doi: 10.1016/j.juro.2012.09.102. Epub 2012 Sep 25.
We established the most common stone composition, and serum and urinary biochemical features in patients with gout and urolithiasis.
We retrospectively searched for the records of patients diagnosed with gout among all those in our stone registry. A matched case cohort of stone formers was generated from our registry who had the same age, gender and body mass index. Primary end points were baseline 24-hour urinary metabolic panels and stone composition. Medications were considered. Groups were compared using the Student t and chi-square/Fisher exact tests with significance considered at p <0.05.
For stone panel evaluation 181 patients met our inclusion criteria. There was no significant difference in 24-hour uric acid between the nongout and gout cohorts but hyperoxaluria was more common in patients with gout (74% vs 61%, p = 0.009). For stone composition analysis 393 patients were included. The gout cohort had lower calcium oxalate monohydrate (39.4% vs 54.7%), calcium oxalate dihydrate (6.0% vs 11.2%) and calcium phosphate (9.6% vs 14.1%) but higher uric acid (42.7% vs 18.2%, each p <0.001). Pure uric acid stones were more common in patients with gout (52.2% vs 22.3%, p <0.001), while calcium oxalate monohydrate (45.2% vs 68.6%, p <0.001), calcium oxalate dihydrate (0.6% vs 3.5%, p = 0.017) and calcium phosphate (1.6% vs 4.9%, p = 0.033) were more common in nongout cases. Patients with gout who were on allopurinol had fewer pure uric acid stones (30.4% vs 56.4%) and more calcium oxalate monohydrate stones (69.6% vs 40.7%, each p <0.001) than those without medication.
Uric acid stones are the most common pure stone composition in patients with gout but 48% have nonuric acid stones. Allopurinol changes the stone composition distribution in patients with gout to a pattern similar to that in stone formers without gout.
我们确定了痛风和尿石症患者最常见的结石成分及血清和尿液生化特征。
我们对所有结石登记患者中痛风患者的记录进行了回顾性搜索。从我们的登记处生成了一个与结石形成者相匹配的病例队列，这些患者的年龄、性别和体重指数相同。主要终点是基线 24 小时尿液代谢物谱和结石成分。考虑到药物因素。使用学生 t 检验和卡方/Fisher 确切概率检验比较组间差异，p 值<0.05 认为有统计学意义。
对于结石组评估，181 例患者符合我们的纳入标准。痛风组和非痛风组患者 24 小时尿酸无显著差异，但痛风患者高草酸尿症更常见（74% vs 61%，p=0.009）。对于结石成分分析，393 例患者纳入研究。痛风组患者一水合草酸钙（39.4% vs 54.7%）、二水合草酸钙（6.0% vs 11.2%）和磷酸钙（9.6% vs 14.1%）的含量较低，但尿酸（42.7% vs 18.2%，均 p<0.001）的含量较高。痛风患者更常见纯尿酸结石（52.2% vs 22.3%，p<0.001），而非痛风患者更常见一水合草酸钙结石（45.2% vs 68.6%，p<0.001）、二水合草酸钙结石（0.6% vs 3.5%，p=0.017）和磷酸钙结石（1.6% vs 4.9%，p=0.033）。正在服用别嘌呤醇的痛风患者纯尿酸结石较少（30.4% vs 56.4%），一水合草酸钙结石较多（69.6% vs 40.7%，均 p<0.001）。
尿酸结石是痛风患者最常见的纯结石成分，但 48%的患者结石成分是非尿酸结石。别嘌呤醇改变了痛风患者的结石成分分布，使其与无痛风结石形成者相似。
