【摘要】：目的:探討代謝綜合征及其各組份對復(fù)雜性腎結(jié)石成分及腎結(jié)石進(jìn)展、復(fù)發(fā)的影響。方法:選取2015年01月-2016年08月在四川省人民醫(yī)院泌尿外科住院治療的腎結(jié)石患者。按照納入及排除標(biāo)準(zhǔn),確定370例腎結(jié)石住院患者為研究對象。首先選取其中158例復(fù)雜性腎結(jié)石患者,研究代謝綜合征及其相關(guān)代謝因素對結(jié)石大小、成分的影響;再將158例復(fù)雜性腎結(jié)石患者作為研究組,212例非復(fù)雜性腎結(jié)石患者作為對照組,分析代謝綜合征相關(guān)代謝因素與腎結(jié)石進(jìn)展的關(guān)系;最后對全部370例腎結(jié)石患者術(shù)后隨訪6個(gè)月,分析代謝綜合征相關(guān)代謝因素與腎結(jié)石復(fù)發(fā)的關(guān)系。結(jié)果:共納入370例腎結(jié)石患者,包括158例復(fù)雜性腎結(jié)石患者、212例非復(fù)雜性腎結(jié)石患者。1、對158例復(fù)雜性腎結(jié)石患者,按照是否伴有代謝綜合征及相關(guān)代謝因素異常(BMI、血壓、血糖、血脂)分別進(jìn)行5次分組,分別比較每個(gè)組間結(jié)石大小、成分,結(jié)果顯示:代謝綜合征、高血糖、高血脂患者結(jié)石水平面直徑大于對照組;伴有代謝綜合征的患者,結(jié)石成分含六水磷酸銨鎂、尿酸結(jié)石的比例較高;伴高血糖的患者,結(jié)石成分含水草酸鈣比例較低、碳酸磷灰石和六水磷酸銨鎂比例較高;伴有高BMI的患者,結(jié)石成分含尿酸的比例較高。2、對復(fù)雜性腎結(jié)石與非復(fù)雜性腎結(jié)石兩組患者的BMI、空腹血糖、血甘油三酯、血高密度脂蛋白膽固醇含量進(jìn)行分析,結(jié)果顯示BMI、空腹血糖、血高密度脂蛋白膽固醇指標(biāo)在兩組人群間有統(tǒng)計(jì)學(xué)差異(P0.05)。多因素Logistic回歸分析顯示BMI、空腹血糖、血高密度脂蛋白膽固醇是腎結(jié)石進(jìn)展成復(fù)雜性腎結(jié)石的獨(dú)立影響因素,其中BMI和空腹血糖每增加1個(gè)單位,復(fù)雜腎結(jié)石發(fā)生風(fēng)險(xiǎn)分別增加1.178倍和1.889倍,而血高密度脂蛋白膽固醇每增加10個(gè)單位復(fù)雜腎結(jié)石發(fā)生的風(fēng)險(xiǎn)將減小0.782倍。3、對370例腎結(jié)石患者術(shù)后隨訪6個(gè)月,將復(fù)發(fā)的80例患者作為研究組,未復(fù)發(fā)的290例作為對照組,對兩組BMI、空腹血糖、血甘油三酯、血高密度脂蛋白膽固醇含量進(jìn)行分析,結(jié)果顯示空腹血糖、血甘油三酯、血高密度脂蛋白膽固醇指標(biāo)在兩組間差異均有統(tǒng)計(jì)學(xué)意義(P0.05)。多因素Logistic回歸分析顯示空腹血糖、血高密度脂蛋白膽固醇是腎結(jié)石復(fù)發(fā)的獨(dú)立影響因素,其中空腹血糖每增加一個(gè)單位,復(fù)發(fā)的風(fēng)險(xiǎn)增加1.819倍,有統(tǒng)計(jì)學(xué)意義(P0.05);血高密度脂蛋白膽固醇每增加10個(gè)單位復(fù)發(fā)發(fā)生的風(fēng)險(xiǎn)將減小0.775倍,有統(tǒng)計(jì)學(xué)意義(P0.05);雖然血甘油三酯每增加1個(gè)單位,發(fā)生復(fù)發(fā)的風(fēng)險(xiǎn)增加1.131倍,但是無統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1、在復(fù)雜性腎結(jié)石患者中,伴有代謝綜合征的患者較不伴有代謝綜合征的患者,結(jié)石水平面直徑更大,結(jié)石成分含六水磷酸銨鎂、尿酸結(jié)石的比例增高;伴高血糖患者較血糖正常患者,結(jié)石水平面直徑更大,結(jié)石成分含一水草酸鈣比例降低,而含碳酸磷灰石、六水磷酸銨鎂比例增高;伴高血脂患者較血脂正�；颊�,結(jié)石水平面直徑更大;伴BMI增大患者較BMI正常患者,結(jié)石成分含尿酸比例增高。2、BMI增大、空腹血糖增高、高密度脂蛋白膽固醇水平降低是影響腎結(jié)石進(jìn)展為復(fù)雜性腎結(jié)石的高危因素。3、空腹血糖增高、高密度脂蛋白膽固醇水平降低是引起腎結(jié)石復(fù)發(fā)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.
【學(xué)位授予單位】：遵義醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R589;R692.4

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