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目的研究绵阳地区上尿路结石成分组成特点,探讨基于结石成分分析结果而制定的预防指导方案的效用。方法纳入2011年6月至2013年10月间非肾输尿管混合部位的上尿路结石患者共374例,采用红外光谱法对结石成分进行分析,根据分析结果选择预防指导方案,随后根据患者采取的不同预防方案进行分组,随访24个月以观察比较组间结石复发率的差异。结果共检测出单一成分结石6种,混合成分结石5种,结石成分比例由高到低分别为草酸钙(78.6%)、碳酸磷灰石(51.9%)、六水磷酸胺镁(22.7%)、无水尿酸(14.4%)、尿酸铵(0.8%)和L-胱氨酸(0.3%),含钙结石的比例达91.4%。经随访发现,采取了预防方案的患者无论哪个时间段以及总的结石复发率(9.7%)均显著小于未预防患者(总复发率23%);无论是严格预防方案还是一般预防方案均能有效预防结石复发;采取严格预防方案患者的结石复发率在0~12个月这个时间段内(1.4%)与采取一般预防方案的患者(6.2%)相比较,差异均有统计学意义(P<0.05)。结论绵阳地区上尿路结石成分以含钙结石为主,针对结石成分进行预防指导能有效的降低结石复发率。
Objective To study the composition of upper urinary tract calculi in Mianyang, and to explore the utility of prevention guidelines based on the results of stone component analysis. Methods A total of 374 patients with upper urinary tract calculi in the non-renal ureter mixed site from June 2011 to October 2013 were included in this study. Infrared spectroscopy was used to analyze the components of the stones. According to the results of the analysis, The different prevention programs were grouped and followed up for 24 months to observe the difference of the recurrence rate between the two groups. Results A total of 6 kinds of single component stones and 5 kinds of mixed component stones were detected. Calcium oxalate (78.6%), carbonated apatite (51.9%) and amine magnesium phosphate hexahydrate (22.7% , Anhydrous uric acid (14.4%), ammonium urate (0.8%) and L-cystine (0.3%). The proportion of calcium-containing stones was 91.4%. At follow-up, patients who took the prophylaxis regimen were significantly less likely to have recurrences (9.7%) than non-prophylaxis patients (23% overall relapse rate) regardless of time course; both the strict regimen and the general prophylaxis regimen were effective The recurrence rate of stones in the patients with strict prevention programs was statistically significant (0.4%) in the period from 0 to 12 months (6.2%) compared with the patients taking the general prevention program (P < 0.05). Conclusion The upper urinary tract stones in Mianyang area are mainly calcium-bearing stones, and the prevention and treatment of stones can effectively reduce the recurrence rate of stones.