代谢综合征与复杂性肾结石成分、肾结石进展、复发之间关系的研究

发布时间：2018-08-18 12:48

【摘要】：目的:探讨代谢综合征及其各组份对复杂性肾结石成分及肾结石进展、复发的影响。方法:选取2015年01月-2016年08月在四川省人民医院泌尿外科住院治疗的肾结石患者。按照纳入及排除标准,确定370例肾结石住院患者为研究对象。首先选取其中158例复杂性肾结石患者,研究代谢综合征及其相关代谢因素对结石大小、成分的影响;再将158例复杂性肾结石患者作为研究组,212例非复杂性肾结石患者作为对照组,分析代谢综合征相关代谢因素与肾结石进展的关系;最后对全部370例肾结石患者术后随访6个月,分析代谢综合征相关代谢因素与肾结石复发的关系。结果:共纳入370例肾结石患者,包括158例复杂性肾结石患者、212例非复杂性肾结石患者。1、对158例复杂性肾结石患者,按照是否伴有代谢综合征及相关代谢因素异常(BMI、血压、血糖、血脂)分别进行5次分组,分别比较每个组间结石大小、成分,结果显示:代谢综合征、高血糖、高血脂患者结石水平面直径大于对照组;伴有代谢综合征的患者,结石成分含六水磷酸铵镁、尿酸结石的比例较高;伴高血糖的患者,结石成分含水草酸钙比例较低、碳酸磷灰石和六水磷酸铵镁比例较高;伴有高BMI的患者,结石成分含尿酸的比例较高。2、对复杂性肾结石与非复杂性肾结石两组患者的BMI、空腹血糖、血甘油三酯、血高密度脂蛋白胆固醇含量进行分析,结果显示BMI、空腹血糖、血高密度脂蛋白胆固醇指标在两组人群间有统计学差异(P0.05)。多因素Logistic回归分析显示BMI、空腹血糖、血高密度脂蛋白胆固醇是肾结石进展成复杂性肾结石的独立影响因素,其中BMI和空腹血糖每增加1个单位,复杂肾结石发生风险分别增加1.178倍和1.889倍,而血高密度脂蛋白胆固醇每增加10个单位复杂肾结石发生的风险将减小0.782倍。3、对370例肾结石患者术后随访6个月,将复发的80例患者作为研究组,未复发的290例作为对照组,对两组BMI、空腹血糖、血甘油三酯、血高密度脂蛋白胆固醇含量进行分析,结果显示空腹血糖、血甘油三酯、血高密度脂蛋白胆固醇指标在两组间差异均有统计学意义(P0.05)。多因素Logistic回归分析显示空腹血糖、血高密度脂蛋白胆固醇是肾结石复发的独立影响因素,其中空腹血糖每增加一个单位,复发的风险增加1.819倍,有统计学意义(P0.05);血高密度脂蛋白胆固醇每增加10个单位复发发生的风险将减小0.775倍,有统计学意义(P0.05);虽然血甘油三酯每增加1个单位,发生复发的风险增加1.131倍,但是无统计学意义(P0.05)。结论:1、在复杂性肾结石患者中,伴有代谢综合征的患者较不伴有代谢综合征的患者,结石水平面直径更大,结石成分含六水磷酸铵镁、尿酸结石的比例增高;伴高血糖患者较血糖正常患者,结石水平面直径更大,结石成分含一水草酸钙比例降低,而含碳酸磷灰石、六水磷酸铵镁比例增高;伴高血脂患者较血脂正常患者,结石水平面直径更大;伴BMI增大患者较BMI正常患者,结石成分含尿酸比例增高。2、BMI增大、空腹血糖增高、高密度脂蛋白胆固醇水平降低是影响肾结石进展为复杂性肾结石的高危因素。3、空腹血糖增高、高密度脂蛋白胆固醇水平降低是引起肾结石复发的高危因素。
[Abstract]:Objective: To investigate the effects of metabolic syndrome and its components on the composition, progression and recurrence of complex renal calculi. Methods: 370 inpatients with renal calculi were selected from January 2015 to August 2016 in the Department of Urology of Sichuan People's Hospital. Among them, 158 patients with complex renal calculi were selected to study the effects of metabolic syndrome and related metabolic factors on the size and composition of calculi, 158 patients with complex renal calculi were selected as study group, 212 patients with non-complex renal calculi as control group, and the relationship between metabolic factors related to metabolic syndrome and the progression of renal calculi was analyzed. Results: A total of 370 patients with renal calculi, including 158 patients with complex renal calculi, 212 patients with non-complex renal calculi, were enrolled in the study. 1. 158 patients with complex renal calculi were enrolled in the study. Abnormal factors (BMI, blood pressure, blood glucose, blood lipids) were divided into five groups, and the size and composition of stones were compared between each group. The results showed that the horizontal diameter of stones in patients with metabolic syndrome, hyperglycemia and hyperlipidemia was larger than that in the control group. The proportion of calcium oxalate hydrate in calculus was lower, the proportion of apatite carbonate and magnesium ammonium phosphate hexahydrate was higher, and the proportion of uric acid in calculus was higher in patients with high BMI. 2. The BMI, fasting blood glucose, triglyceride and high density lipoprotein cholesterol were measured in patients with complex and non-complex renal calculi. Multivariate logistic regression analysis showed that BMI, fasting blood glucose and high density lipoprotein cholesterol were independent factors for the progression of renal calculi to complex renal calculi. The risk of complex kidney stones increased by 1.178 and 1.889 times respectively, while the risk of complex kidney stones decreased by 0.782 times for every 10 units of high-density lipoprotein cholesterol. After 6 months follow-up of 370 patients with renal stones, 80 patients with recurrence were treated as study group, 290 patients without recurrence as control group, and BMI, empty for both groups. The levels of fasting blood glucose, triglyceride and high density lipoprotein cholesterol were analyzed. The results showed that there were significant differences in fasting blood glucose, triglyceride and high density lipoprotein cholesterol between the two groups (P 0.05). Multivariate logistic regression analysis showed that fasting blood glucose and high density lipoprotein cholesterol were the recurrence of renal calculi. The risk of recurrence increased by 1.819 times per unit of increase in fasting blood glucose (P 0.05); the risk of recurrence decreased by 0.775 times per 10 units of increase in high-density lipoprotein cholesterol (P 0.05); although the risk of recurrence increased by 1 unit of increase in triglyceride, the risk of recurrence increased by 1. Conclusion: 1. In patients with complex renal calculi, patients with metabolic syndrome had larger horizontal diameter of calculi, higher proportion of calculi containing magnesium ammonium phosphate hexahydrate and uric acid calculi, and those with hyperglycemia had larger horizontal diameter of calculi than those without metabolic syndrome. The proportion of calcium oxalate monohydrate in calculus was lower, but the proportion of calcium oxalate monohydrate in calcium carbonate and magnesium ammonium phosphate hexahydrate was higher; the diameter of calculus horizontal plane was larger in patients with hyperlipidemia than in patients with normal blood lipids; the proportion of uric acid in calculus components was higher in patients with increased BMI than in patients with normal BMI. 2. BMI increased, fasting blood glucose and high density lipoprotein cholesterol. Low alcohol levels are high-risk factors for the progression of renal calculi to complex renal calculi. 3. Increased fasting blood glucose and decreased high-density lipoprotein cholesterol levels are high-risk factors for the recurrence of renal calculi.
【学位授予单位】：遵义医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R589;R692.4

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