Machoy P
Ośrodka Diagnostyki Medycznej Wojewódzkiego Szpitala Zespolonego w Szczecinie.
Ann Acad Med Stetin. 1995;41:259-71.
Urolithiasis is the most frequent disease of urinary system. It affects about 3% of people of the productive age. One half of the hospitalized in Departments of Urology is made up of patients with urinary calculi. In some regions of the globe, urolithiasis is a very common pathological disorder. Upper Silesia being such a region in Poland. The objective of the paper is: 1) systematization of calculi according to their mineral composition with regard to eventual prophylaxis of urolithiasis, 2) comparison of mineral components of calculi in the aspect of pollutions for Upper Silesia and West Pomerania territories, and the effect of external factors on the constitution of the formed calculi, 3) making use of X-ray microanalysis in complex determinations of mineral compositions of stones, particularly the trace elements. For that purpose a total of 185 urinary calculi stemming from individuals of both sexes, aged 24 to 82 years were used. The content of calcium, magnesium, zinc and iron was determined by atom absorption method, that of aluminium, chloride, sulphur and copper by X-ray microanalysis method, fluoride by gas chromatographic method, phosphates and urates by colorimetric method. The content of cystine was defined by thermic decomposition and characteristic smell. The results were subjected to statistical analysis. With reference to the first task, the following chemical classification of stones has been suggested, namely; class I: ammonium stones being magnesium-ammonium phosphate, class II: stones with elevated calcium content, calcium oxalate, class III: stones with elevated magnesium content, class IV: calculi rich in calcium and magnesium, class V: calculi deficient in calcium and magnesium, class VI: organic uric stones, class VII: organic cystine stones. The second task consisted in comparing the mineral composition of stones from subjects inhabiting two remote from each other regions-industrialized Silesia and Pomerania (Tab. 10). The statistical analysis has revealed differences being statistically significant only with regard to calcium and magnesium in Silesia and Pomerania groups. Undoubtedly that is of importance when one takes into consideration that calcium and magnesium display high affinity to fluoride, the presence of which was detected in all the stones and which may influence the physicochemical properties of the urinary calculi, first of all their hardness and solubility. The third task consisted in evaluating the possibility of applying the X-ray microanalysis for searching the stone for further elements principally microelements. The performed study comprised 10 stones: Silesia region and Pomerania region, whose composition was compared pairwise. The pairs were selected in such a manner that they should have some features in common found out by previously described atom absorption methods. The established results concerning calcium, magnesium and phosphorus showed in general compatibility of results obtained by the two methods. However, by X-ray microanalysis method it was possible to detect further elements: sulphur, aluminium, chloride and copper. The following conclusions have been drawn, namely: 1) analytic examinations of mineral composition of urinary calculi are the base of their chemical composition with regard to eventual prophylaxis of urolithiasis, 2) a varied composition of urinary calculi from two different regions of Poland may be the reflection of actual state of natural environment pollution in those regions, 3) presence of fluoride in all the urinary calculi allows us to suppose that it is permanent element of urinary calculi.
尿石症是泌尿系统最常见的疾病。它影响约3%的育龄人群。泌尿外科住院患者中有一半是尿路结石患者。在世界上的一些地区,尿石症是一种非常常见的病理紊乱。波兰的上西里西亚地区就是这样一个地区。本文的目的是:1)根据结石的矿物质成分对结石进行系统化,以考虑尿石症的最终预防;2)比较上西里西亚和西波美拉尼亚地区结石的矿物质成分在污染方面的情况,以及外部因素对形成结石成分的影响;3)利用X射线微分析法对结石的矿物质成分进行综合测定,特别是微量元素。为此,共使用了185块来自24至82岁男女个体的尿路结石。钙、镁、锌和铁的含量通过原子吸收法测定,铝、氯、硫和铜的含量通过X射线微分析法测定,氟化物通过气相色谱法测定,磷酸盐和尿酸盐通过比色法测定。胱氨酸的含量通过热分解和特征气味来确定。对结果进行了统计分析。关于第一项任务,建议了以下结石的化学分类,即:I类:铵结石,即磷酸镁铵;II类:钙含量升高的结石,草酸钙;III类:镁含量升高的结石;IV类:富含钙和镁的结石;V类:钙和镁含量不足的结石;VI类:有机尿酸结石;VII类:有机胱氨酸结石。第二项任务包括比较来自两个彼此相距遥远的地区——工业化的西里西亚和波美拉尼亚——的受试者的结石矿物质成分(表10)。统计分析表明,仅西里西亚组和波美拉尼亚组在钙和镁方面的差异具有统计学意义。考虑到钙和镁对氟具有高亲和力,而在所有结石中都检测到了氟的存在,并且氟可能会影响尿路结石的物理化学性质,首先是其硬度和溶解度,这无疑是很重要的。第三项任务包括评估应用X射线微分析法寻找结石中其他元素(主要是微量元素)的可能性。所进行的研究包括10块结石:西里西亚地区和波美拉尼亚地区的结石,将它们的成分两两进行比较。这些对子的选择方式是,它们应具有通过先前描述的原子吸收法发现的一些共同特征。关于钙、镁和磷的既定结果总体上显示了两种方法获得的结果的兼容性。然而,通过X射线微分析法有可能检测到其他元素:硫、铝、氯和铜。得出了以下结论,即:1)尿路结石矿物质成分的分析检查是其化学组成的基础,有助于尿石症的最终预防;2)来自波兰两个不同地区的尿路结石成分各异,可能反映了这些地区自然环境污染的实际状况;3)所有尿路结石中都存在氟,这使我们推测它是尿路结石的一个常量元素。