The value of 24 h urine metabolic assessment combined with renal function in the diagnosis of upper urinary tract uric acid stones
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摘要: 目的探讨24 h尿液代谢评估联合肾功能指标在上尿路尿酸结石诊断中的价值。方法回顾性分析2019年2月—2022年1月我院495例上尿路结石患者的临床资料，根据术后结石成分分析结果分为尿酸结石组(43例)与非尿酸结石组(452例)，比较两组间的临床指标差异。应用ROC曲线确定不同指标的最佳截断值并进行分组，通过单因素及多因素logistic回归分析上尿路尿酸结石形成的独立危险因素。结果尿酸结石组与非尿酸结石组年龄、血尿素、肌酐、尿酸、尿pH、24 h尿枸橼酸、24 h尿钙以及BMI≥25 kg/m2、高血压、高血糖、高血脂比例均差异有统计学意义(均P < 0.05)。logistic回归分析结果显示，年龄≥49.5岁(OR=2.767，95%CI：1.026~7.463)、高血糖(OR=3.362，95%CI：1.216~8.750)、血肌酐≥92.4 μmol/L(OR=3.462，95%CI：1.366~8.776)、血尿酸≥443.6 μmol/L(OR=2.564，95%CI：1.093~6.018)、尿pH≤5.7(OR=7.586，95%CI：3.158~18.226)、尿钙≤3.15 mmol/24 h(OR=3.753，95%CI：1.439~9.787)是上尿路尿酸结石的独立危险因素。结论年龄、高血糖、血肌酐、血尿酸、尿pH及24 h尿钙是上尿路尿酸结石形成的危险因素，可作为上尿路尿酸结石诊疗的临床依据。Abstract: ObjectiveTo explore the value of 24 h urine metabolic assessment combined with renal function indexes in the diagnosis of uric acid stones in the upper urinary tract.MethodsThe clinical data of 495 patients with upper urinary tract stones in our hospital from February 2019 to January 2022 were retrospectively analyzed. According to the results of stone composition analysis after surgery, they were divided into uric acid stone group(n=43) and non uric acid stone group(n=452), the differences of clinical indexes between the two groups were compared. Receiver operating characteristic(ROC) curve was performed on these indexes to obtain the cut-off value and the patients were grouped according to it. The independent risk factors of upper urinary tract uric acid stone were analyzed by univariate and multivariate logistic regression.ResultsThe differences in age, blood urea, serum creatinine, blood uric acid, urine pH, 24 h urinary citrate, 24 h urinary calcium, BMI≥25 kg/m2, hypertension, hyperglycemia and hyperlipidemia between the two groups were statistically significant(all P < 0.05). Logistic regression analysis showed that age≥49.5 years old(OR=2.767, 95%CI: 1.026-7.463), hyperglycemia(OR=3.362, 95%CI: 1.216-8.750), serum creatinine≥92.4 μmol/L(OR=3.462, 95%CI: 1.366-8.776), blood uric acid≥443.6 μmol/L(OR=2.564, 95%CI: 1.093-6.018), urine pH≤5.7(OR=7.586, 95%CI: 3.158-18.226), and urinary calcium≤3.15 mmol/24 h(OR=3.753, 95%CI: 1.439-9.787) were independent risk factors of upper urinary tract uric acid stones.ConclusionAge, hyperglycemia, serum creatinine, blood uric acid, urinary pH, and 24 h urinary calcium are risk factors for the formation of upper urinary tract uric acid stones, and they can be used as clinical basis for the diagnosis and treatment of it.
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表 1 尿酸结石组与非尿酸结石组临床资料比较
例(%)，X±S 项目 尿酸结石组(43例) 非尿酸结石组(452例) Z/χ2值 P值 年龄/岁 58.30±12.79 48.31±12.56 -4.340 < 0.01 性别 1.326 0.25 男 31(72.1) 286(63.3) 女 12(27.9) 166(36.7) BMI≥25 kg/m2 26(60.5) 195(43.1) 4.768 0.03 高血压 31(72.1) 245(54.2) 5.094 0.02 高血糖 18(41.9) 52(11.5) 29.80 < 0.01 高血脂 30(69.8) 231(51.1) 5.486 0.02 血尿素/(mmol·L-1) 9.00±4.00 5.61±1.96 -6.325 < 0.01 血肌酐/(μmol·L-1) 129.41±85.17 77.42±41.60 -6.195 < 0.01 血尿酸/(μmol·L-1) 470.09±129.82 372.61±97.03 -4.873 < 0.01 尿pH 5.51±0.44 6.15±0.56 -6.961 < 0.01 尿尿酸/[μmol·(24 h)-1] 3171.47±1005.01 3237.77±1113.62 -0.106 0.92 尿草酸/[mmol·(24 h)-1] 0.43±0.27 0.42±0.26 -0.131 0.90 尿枸橼酸/[mmol·(24 h)-1] 0.66±0.63 0.98±0.74 -3.371 < 0.01 尿磷酸/[mmol·(24 h)-1] 16.26±7.26 16.51±7.00 -0.052 0.96 尿氯/[mmol·(24 h)-1] 168.74±65.91 182.71±88.17 -0.687 0.49 尿钾/[mmol·(24 h)-1] 25.98±8.18 28.92±11.42 -1.601 0.11 尿钠/[mmol·(24 h)-1] 172.06±68.61 185.04±89.69 -0.590 0.56 尿钙/[mmol·(24 h)-1] 2.41±1.51 4.62±2.25 -6.792 < 0.01 尿镁/[mmol·(24 h)-1] 3.24±1.35 3.14±1.68 -0.77 0.44 
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表 2 不同指标诊断上尿路尿酸结石的ROC曲线分析
项目 AUC 标准误 P值 95%CI 截断值 敏感度 特异度 年龄 0.700 0.040 < 0.01 0.621~0.779 49.50 0.814 0.511 血尿素 0.792 0.039 < 0.01 0.714~0.869 6.35 0.698 0.750 血肌酐 0.786 0.041 < 0.01 0.706~0.866 92.40 0.651 0.852 血尿酸 0.725 0.045 < 0.01 0.636~0.814 443.60 0.628 0.801 pH 0.810 0.033 < 0.01 0.745~0.875 5.74 0.767 0.748 24 h尿枸橼酸 0.655 0.046 < 0.01 0.566~0.745 0.52 0.628 0.659 24 h尿钙 0.813 0.034 < 0.01 0.746~0.880 3.15 0.791 0.719
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表 3 尿酸结石组与非尿酸结石组单因素logistic回归分析
项目 B值 OR(95%CI) P值 年龄≥49.5岁 1.520 4.573(2.076~10.075) < 0.01 BMI≥25 kg/m2 0.701 2.016(1.064~3.819) 0.03 高血压 0.781 2.183(1.093~4.358) 0.03 高血糖 1.712 5.538(2.831~10.837) < 0.01 高血脂 0.792 2.208(1.123~4.342) 0.02 血尿素≥6.35 mmol/L 1.935 6.923(3.491~13.730) < 0.01 血肌酐≥92.4 μmol/L 2.373 10.726(5.441~21.145) < 0.01 血尿酸≥443.6 μmol/L 1.915 6.787(3.508~13.133) < 0.01 尿pH≤5.7 2.281 9.784(4.674~20.480) < 0.01 尿枸橼酸≤0.52 mmol/24 h 1.095 2.989(1.573~5.677) < 0.01 尿钙≤3.15 mmol/24 h 2.269 9.668(4.508~20.730) < 0.01
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表 4 尿酸结石组与非尿酸结石组多因素logistic回归分析
项目 B值 OR(95%CI) P值 年龄≥49.5岁 1.018 2.767(1.026~7.463) 0.04 BMI≥25 kg/m2 0.400 1.492(0.625~3.562) 0.37 高血压 -0.002 0.998(0.408~2.443) 0.99 高血糖 1.182 3.262(1.216~8.750) 0.02 高血脂 0.255 1.291(0.524~3.178) 0.58 血尿素≥6.35 mmol/L 0.182 1.200(0.452~3.185) 0.72 血肌酐≥92.4 μmol/L 1.242 3.462(1.366~8.776) < 0.01 血尿酸≥443.6 μmol/L 0.942 2.564(1.093~6.018) 0.03 尿pH≤5.7 2.026 7.586(3.158~18.226) < 0.01 尿枸橼酸≤0.52 mmol/24 h 0.539 1.714(0.682~4.309) 0.25 尿钙≤3.15 mmol/24 h 1.323 3.753(1.439~9.787) < 0.01
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