青藏高原地区不同民族居民泌尿系结石成分分析
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摘要
目的探讨青藏高原地区汉族、藏族、回族居民泌尿系结石成份差异,针对性提出防治依据。方法选取2016年3月—2018年3月我院及青海省人民医院、青海省中医院、解放军第4医院诊治青藏高原地区泌尿系统结石患者242例临床资料行回顾性分析,根据患者民族不同分为汉族组、藏族组、回族组,比较各组性别、年龄、地区、结石部位,采用红外光谱分析并各组结石成分。结果汉族组、藏族组及回族组泌尿系统结石患者男性均多于女性,但藏族、回族男性发病率更高(P<0.05);汉族组、藏族组、回族组患者年龄、地区、结石部位、结石直径比较无统计学意义(P>0.05)。上尿路结石成分:汉族组、藏族组、回族组上尿路结石以草酸钙为主,其次为草酸钙和磷酸钙混合成分、碳酸磷灰石、无水尿酸、尿酸铵、六水磷酸镁铵,只有汉族患者检测有二水磷酸氢钙成分,各组间结石成分比较无统计学意义(P>0.05)。下尿路结石:汉族组、藏族组以草酸钙为主且显著高于回族组,回族组以碳酸磷灰石为主且高于汉族组和藏族组,只有汉族组中检测二水磷酸氢钙成分且与藏族组、回族组比较有统计学意义(P<0.05);各组间无水尿酸、六水磷酸镁铵、尿酸铵、草酸钙、磷酸钙混合成分比较无统计学意义(P>0.05)。结论青藏高原地区就诊泌尿系统结石患者中男性多于女性。汉族、藏族、回族上尿路结石患者以草酸钙为主,汉族和藏族下尿路结石以草酸钙为主,回族下尿路结石以碳酸磷灰石为主,仅在汉族结石患者中可检测二水磷酸氢钙成分。
Objective To explore the differences in urinary stone compositions among residents of the Han,Tibetan and Hui ethnic groups living on the Qinghai-Tibetan Plateau,in order to provide basis for prevention and control of urinary stones.Methods The clinical data of 242 cases of urinary stones treated during March,2016 and March,2018 were retrospectively analyzed.The patients were divided according to their nationalities into the Han group,Tibetan group,and Hui group.The sex,age,region,and stone location were compared.The compositions of stones were determined with infrared spectroscopy.Results There were no statistical differences in the sex,age,region,stone location and stone diameter among the three groups(P>0.05).The incidence of urinary calculi was higher among males than in females in all three groups,while the Tibetan and Hui males had higher incidence than the Han males(P<0.05).The upper urinary tract stones in all three groups were mainly calcium oxalate,followed by mixture of calcium oxalate and calcium phosphate,carbonate apatite,anhydrous uric acid,ammonium urate,and magnesium phosphate hexahydrate ammonium;the dihydrate calcium phosphate was detected only in the Han group;there were no significant differences in the stone compositions among the groups(P>0.05).For the lower urinary tract stones,the Han and Tibetan groups had mainly calcium oxalate,while the Hui group had mainly carbonate apatite,and only the Han group had calcium diphosphate dihydrate(P<0.05);there were no significant differences in the composition of anhydrous uric acid,magnesium ammonium phosphate hexahydrate,ammonium urate,calcium oxalate,and calcium phosphate among the groups(P>0.05).Conclusion The incidence of urinary calculi is higher in males than in females.Calcium oxalate is the major constituent of upper urinary tract calculi in the Han,Tibetan,and Hui nationalities,and the major constituent of lower urinary tract stones in the Han and Tibetan races.Carbonate apatite is the major constituent in the Hui nationality.Calcium diphosphate dihydrate is detected in the Han patients.
Objective To explore the differences in urinary stone compositions among residents of the Han,Tibetan and Hui ethnic groups living on the Qinghai-Tibetan Plateau,in order to provide basis for prevention and control of urinary stones.Methods The clinical data of 242 cases of urinary stones treated during March,2016 and March,2018 were retrospectively analyzed.The patients were divided according to their nationalities into the Han group,Tibetan group,and Hui group.The sex,age,region,and stone location were compared.The compositions of stones were determined with infrared spectroscopy.Results There were no statistical differences in the sex,age,region,stone location and stone diameter among the three groups(P>0.05).The incidence of urinary calculi was higher among males than in females in all three groups,while the Tibetan and Hui males had higher incidence than the Han males(P<0.05).The upper urinary tract stones in all three groups were mainly calcium oxalate,followed by mixture of calcium oxalate and calcium phosphate,carbonate apatite,anhydrous uric acid,ammonium urate,and magnesium phosphate hexahydrate ammonium;the dihydrate calcium phosphate was detected only in the Han group;there were no significant differences in the stone compositions among the groups(P>0.05).For the lower urinary tract stones,the Han and Tibetan groups had mainly calcium oxalate,while the Hui group had mainly carbonate apatite,and only the Han group had calcium diphosphate dihydrate(P<0.05);there were no significant differences in the composition of anhydrous uric acid,magnesium ammonium phosphate hexahydrate,ammonium urate,calcium oxalate,and calcium phosphate among the groups(P>0.05).Conclusion The incidence of urinary calculi is higher in males than in females.Calcium oxalate is the major constituent of upper urinary tract calculi in the Han,Tibetan,and Hui nationalities,and the major constituent of lower urinary tract stones in the Han and Tibetan races.Carbonate apatite is the major constituent in the Hui nationality.Calcium diphosphate dihydrate is detected in the Han patients.
引文
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[19]祁玥,王维,周双喜,等.应用综合水质标识指数法评价分析青海湖水质[J].湖北农业科学,2015,54(6):1331-1334.
[20]齐勇,汤春波,翁国斌,等.泌尿结石感染患者血清降钙素原与C-反应蛋白及白细胞介素6表达的诊断意义[J].中华医院感染学杂志,2016,26(19):4482-4484.
[2]PRADERE B,PEYRONNET B,BROCHARD C.et al.Urinary stones and bowel diseases:Systematic review[J].Progres en urologie,2015,25(10):557-564.
[3]YEO YJ,KIM SH,KIM MJ,et al.Diagnostic efficiency of splitbolus dual-energy computed tomography for patients with suspected urinary stones[J].J Comput Assist Tomogr,2015,39(1):25-31.
[4]RODGERS AL,WEBBER DR,RONICA WL,et al.Folium pyrrosiae ingestion has no effect on the thermodynamic or kinetic urinary risk factors for calcium oxalate urolithiasis in healthy subjects:apoor prognosis for alternative treatment in this type of stone former[J].Urolithiasis,2015,43(1):21-27.
[5]RAMASWAMY KK,DAVID W,KAPAHI P,et al.The elementome of calcium-based urinary stones and its role in urolithiasis[J].Nature Rev Urol,2015,12(10):543-557.
[6]王宏宾,于国英,王芝,等.青海地区藏、回族肝硬化患者血清瘦素水平及其基因C2549A多态性研究[J].实用医学杂志,2015,31(15):2489-2492.
[7]谢莹莺,赵海宁,杨娟,等.青海地区子痫前期与可溶性人类白细胞相关抗原G和脐动脉血流动力学相关性研究[J].中国全科医学,2015,18(26):3181-3184.
[8]谢莹莺,赵海宁,裴青青,等.青海地区不同海拔藏汉民族子痫前期患者人类白细胞抗原G表达研究[J].中国全科医学,2017,20(16):1978-1982.
[9]沈有录,刘维军,张青,等.青海地区冠心病危险因素与冠状动脉病变的相关分析[J].重庆医学,2015,44(35):4943-4945,4949.
[10]王晋龙,王峰,李传洪,等.拉萨地区214例泌尿系结石成分分析[J].现代泌尿外科杂志,2016,21(8):614-616.
[11]叶海云,许清泉,马凯,等.内镜治疗的输尿管结石患者治疗前结石位置和输尿管扩张特点分析[J].北京大学学报:医学版,2017,49(4):622-625.
[12]邓绍强,杜勇,杨汉丰,等.16层螺旋CT多平面重建对输尿管结石的诊断价值[J].实用放射学杂志,2015,31(11):1814-1816.
[13]林海利,郑周达,杨明根,等.经皮肾镜与输尿管软镜在孤立肾结石的应用比较[J].中国微创外科杂志,2016,16(4):301-303,307.
[14]邓青富,姜睿,裴利军,等.电子输尿管软镜与微创经皮肾镜碎石术治疗肾结石的比较[J].实用医学杂志,2016,32(5):721-723.
[15]张应爱,王顺兰,罗思琴,等.海南地区557例泌尿系结石成分分析[J].海南医学,2017,28(3):417-420.
[16]LCHIYANAGI ON,AKIRA L.Age-related delay in urinary stone clearance in elderly patients with solitary proximal ureteral calculi treated by extracorporeal shock wave lithotripsy[J].Urolithiasis,2015,43(5):419-426.
[17]KLIMESOVA,KW,JONATHAN M,HATCH M,et al.Bifidobacterium animalis subsp lactis decreases urinary oxalate excretion in a mouse model of primary hyperoxaluria[J].Urolithiasis,2015,43(2):107-117.
[18]鲁子豫,马燕,李志强,等.青海长江源区2005~2012年地表水水质状况及变化趋势分析[J].水资源保护,2015,31(3):53-56,62.
[19]祁玥,王维,周双喜,等.应用综合水质标识指数法评价分析青海湖水质[J].湖北农业科学,2015,54(6):1331-1334.
[20]齐勇,汤春波,翁国斌,等.泌尿结石感染患者血清降钙素原与C-反应蛋白及白细胞介素6表达的诊断意义[J].中华医院感染学杂志,2016,26(19):4482-4484.