草酸钙尿路结石术后复发与湿热体质的相关性研究

目的:对草酸钙尿路结石术后的复发情况与人体湿热体质的相关性进行研究。方法:采用回顾性分析方式,从2012年1月至2013年1月来我院治疗草酸钙尿道结石的患者病例中选出61例,对患者进行中医辨证诊断,将其中属于湿热体质的患者分为一组,作为研究组;将非湿热体质的患者分为一组,作为对比组,分别记录两组患者的一般资料、结石复发位置、结石复发时间等相关数据,并对其进行对比分析。结果:对两组数据进行分析可以看出,研究组中男性患者数量明显高于对比组,但女性患者数量两组没有较大差异。研究组中青壮年患者数量明显对于对比组,同时两组患者的结石复发部位分布结果没有较大差异,另外在手术后,肾结石发生的残留情况较多,其也是影响因素之一。结论:在对草酸钙尿路结石患者进行治疗后,湿热体质患者的复发率明显要与非湿热体质,并且性别、年龄、结石位置等因素均对复发情况具有影响,需要相关医疗人员进行重点注意。     

2015-2016年宿州市肾结石患病现况调查及危险因素分析

摘要 目的：分析2015-2016年安徽省宿州市肾结石患病情况,并分析该地区肾结石患病的危险因素,为肾结石的防治提供依据。方法：选择2015年1月~2016年12月间于我院就诊的肾结石患者110例作为研究组,选择同期本院体检的健康志愿者110例作为对照组。调查两组基本信息、临床资料、饮食习惯等,并应用单因素和多因素Logistic回归分析分析肾结石患病的危险因素。结果：108名肾结石患者年龄18~75岁,45~55岁所占比例最高,占34.04%,其次是35~44岁,占25.53%,55~64岁,占17.02%。单因素分析显示,宿州市肾结石患者发病与吸烟指数、饮酒指数、饮食习惯、每日饮水量、直系亲属肾结石史、尿路感染史、BMI有关（P<0.05）,与文化程度、月收入无关（P>0.05）。多因素Logistic回归分析结果显示饮酒指数≥200、喜食肉蛋、喜食海鲜、每日饮水量<1000 mL、直系亲属有肾结石史、有尿路感染史、体质量指数(BMI)>24 kg/m²是宿州市肾结石患者发病的危险因素（P<0.05）。结论：宿州市肾结石患者发病年龄多集中于45~55岁,且该地区发病的危险因素包括饮酒指数≥200、喜食肉蛋、喜食海鲜、每日饮水量<1000 mL、直系亲属有肾结石史、有尿路感染史、BMI>24 kg/m²,可作为防治肾结石的参考依据。     

治疗和粉碎肾结石的新技术

由于西方社会人们长期食用高醣、高蛋白、低纤维食物,因而导致输尿管结石和肾结石病人的普遍增加,在西欧,尿路结石患者的发病率估计约占人口的3～4%。据德意志联邦共和国健康保险公司统计,每年做肾结石和输尿管结石手术的人数竟达46,000人。因此,控制尿路结石在医学上是非常重要的。常规排除肾结石和大多数输尿管结石需要一个损伤性的外科手术,还需要1～3个星期的住院治疗及1～3个月的恢复期。此外,病人的腰部还会留下个切口。近年来,经皮肾结石去除术和体外碎石术已逐渐被临床采用。这两种技术的应用大大减少了肾结石的复发率,缩短了常规结石手术的治疗时间。     

健康教育对预防系统性红斑狼疮患者复发率的影响

目的 探讨健康教育对预防系统性红斑狼疮(SLE)患者复发的影响.方法 将2009~2010年我科收治行常规药物治疗和卫生宣教的128例SLE患者为对照组;将2011~2012 年收治行规范化治疗和连续系统的健康教育的136例SLE患者为观察组,即将健康教育贯穿于病人住院期间及出院后1年,根据病人不同时期的身心需求,实施连续系统的健康教育.结果 两组患者均病情好转出院,随访1年,观察组所有患者均坚持服药、建立良好生活方式、定期来院复查和化疗,仅3例病情复发,复发率为2.2%;对照组仅76%患者定期来院复查和化疗,复发16例,复发率为12.5%,明显高于观察组.结论 对SLE患者进行规范化治疗和连续系统的健康教育、定期随访,可有效的预防和减少SLE复发率及并发症发生率,提高患者生活质量.     

内镜套扎治疗门静脉海绵样变性食道静脉曲张破裂出血的疗效分析

目的:探讨内镜下曲张静脉套扎术(EVE)治疗门静脉海绵样变性引起食道静脉曲张破裂出血的疗效.方法:回顾性分析了2004年3月～2007年8月,我院采用内镜下曲张静脉套扎术治疗15例门静脉海绵样变性引起食道静脉曲张破裂出血的临床资料.结果:15例患者经EVL治疗均能有效控制出血,其急诊止血率达93.3%;经1-3次EVL治疗后曲张静脉基本消失,消失率达86.7%;随访6个月～4.1年,一年期静脉曲张复发率为38.5%,两年期静脉曲张复发率为33.3%,三年期静脉曲张复发率为25%,四年期静脉曲张复发率为0.在整个随访期中有8例患者自第一次EVL术后食管曲张静脉基本消失从未复发.结论:EVL治疗门静脉海绵样变性引起食道静脉曲张破裂出血是一种安全有效、简单易行的方法,可以起到急诊止血、消除曲张静脉和预防再出血的作用.     

糖尿病合并肾结石的超声诊断临床研究

目的:分析2型糖尿病(T2DM)患者合并肾结石的超声声象图特点,以期提高临床诊断率(检出率).方法:采用回顾性分析方法,分别观察16例T2DM伴肾结石组患者与32例肾结石组患者的B超声象图及临床表现,并进行差异性比较.结果:2型糖尿病伴肾结石组患者与肾结石组患者相比较,1 声象图特点前者表现多样化,该组病例有90%累双肾,有80%为多发的小结石,与肾结石组患者组相比较有统计学意义(P<0.01).临床表现有70%为无痛性血尿,有统计学意义(P<0.01).结论:2型糖尿病伴肾结石组患者声象图特点表现多样化,多累双肾、多为多发的小结石.临床表现多为无痛性血尿.     

钙和乳制品摄入与肾结石风险关系的研究进展

综述了近年来国内外关于钙和乳制品摄入对预防肾结石形成及复发的相关研究进展,结果表明：无论是对健康人还是结石患者,通过乳制品维持正常或较高的钙摄入水平有助于降低肾结石风险,而钙补充剂不能替代乳制品发挥这一有益作用。     

吡柔比星预防浅表性膀胱癌术后复发的疗效观察

目的：比较吡柔比星与吉西他滨膀胱内灌注预防浅表性膀胱癌术后复发的疗效。方法：40 例浅表性膀胱癌患者根据随机抽 签法分为治疗组与对照组各20 例,所有患者都采用经尿道膀胱肿瘤电切方法,对照组用吉西他滨,治疗组用吡柔比星进行膀胱 灌注,比较两组患者术后复发率的不同。结果：所有患者都完成治疗,随访1 年,治疗组的复发率为5.0 %,对照组为25.0 %,治疗 组的复发率明显低于对照组,对比差异明显,有统计学意义(P<0.05)。经过观察,治疗组的膀胱刺激症状、骨髓抑制、尿道狭窄等不 良反应总体发生率明显少于对照组,两者比较有统计学意义(P<0.05)。结论：相对于吉西他滨,吡柔比星膀胱内灌注预防浅表性膀 胱癌术后复发有很好的效果,不良反应少,在临床上需要根据患者的实际情况来选择不同的灌注药物。     

浅议泌尿系结石的治疗进展

泌尿系结石作为一种全球性的疾病,其人群患病率为19／6～5％,治疗后易复发,半年复发率为5．8％,1年复发率为14%,10年复发率高达30%～70%。虽然外科治疗已取得了巨大进展,但其发病率和复发率居高不下,尤其是上尿路结石仍有继续升高的趋势。因此,针对其病因的诊断和防治越来越受到重视,同时也取得了一些进展。     

425 例结节性甲状腺肿患者术后复发影响因素的分析

目的:探讨结节性甲状腺肿复发的影响因素。方法:分别对本院425例结节性甲状腺肿患者随访1年至8年;采用SPSS软件对复发相关因素进行单因素和多因素Logistic回归分析。结果:随访患者中有39例复发,复发率为9.18%。分析结果显示,两侧甲状腺结节数量越多,结节性甲状腺肿复发率越高(OR=2.631),双侧结节性甲状腺肿患者比单侧患者复发率高(OR=2.758),与接受正规替代治疗者相比,未接受替代治疗及接受非正规替代治疗者更易复发(OR=7.577/4.151),与单纯结节切除术相比,一侧加峡部全切、对侧部分/次全切除术术后复发率低(OR=0.209)。结论:结节性甲状腺肿患者术后复发率较高,针对上述各种影响因素,在临床上相应的治疗措施可有效预防结节性甲状腺肿的复发。     

Causes and prevention of calcium-containing renal calculi.

Kidney stones are common, and recurrences are the rule. At least 90% of patients with kidney stones probably have some identifiable metabolic risk factor. Effective prophylaxis is often available, but with the relatively low rate of recurrence, compliance with the treatment may be a problem. Studies are required to determine the cost-effectiveness of metabolic investigation and prophylactic therapy versus the possible need for repeated treatment by means of extracorporeal lithotripsy, especially in patients having a first calcium oxalate stone.     

Sialylation of urinary prothrombin fragment 1 is implicated as a contributory factor in the risk of calcium oxalate kidney stone formation

Urinary glycoproteins are important inhibitors of calcium oxalate crystallization and adhesion of crystals to renal cells, both of which are key mechanisms in kidney stone formation. This has been attributed to glycosylation of the proteins. In South Africa, the black population rarely form stones (incidence < 1%) compared with the white population (incidence 12-15%). A previous study involving urinary prothrombin fragment 1 from both populations demonstrated superior inhibitory activity associated with the protein from the black group. In the present study, we compared N-linked and O-linked oligosaccharides released from urinary prothrombin fragment 1 isolated from the urine of healthy and stone-forming subjects in both populations to elucidate the relationship between glycosylation and calcium oxalate stone pathogenesis. The O-glycans of both control groups and the N-glycans of the black control samples were significantly more sialylated than those of the white stone-formers. This demonstrates a possible association between low-percentage sialylation and kidney stone disease and provides a potential diagnostic method for a predisposition to kidney stones that could lead to the implementation of a preventative regimen. These results indicate that sialylated glycoforms of urinary prothrombin fragment 1 afford protection against calcium oxalate stone formation, possibly by coating the surface of calcium oxalate crystals. This provides a rationale for the established roles of urinary prothrombin fragment 1, namely reducing the potential for crystal aggregation and inhibiting crystal-cell adhesion by masking the interaction of the calcium ions on the crystal surface with the renal cell surface along the nephron.     

Kidney Stones

The prevalence of kidney stones has steadily risen during this century; passage of a calculus and a positive family history increase the probability of recurrence. Findings from recent studies on the cause of renal calculi have stressed crystallization and crystal aggregation of stone minerals from supersaturated urine, rather than excessive organic matrix. Absence of normal urine inhibitors of calcium salts is also stressed. Formation of calcium oxalate stones is the major problem. Therapy with decreased calcium and oxalate intake, thiazides, phosphate salts and allopurinol in various combinations has substantially decreased the prevalence of recurrent stones. The rationale for the use of allopurinol is that uric acid salts enhance the tendency for calcium oxalate to crystallize from supersaturated urine. The hypercalciuria seen in 30 percent to 40 percent of patients with oxalate stones is usually caused by intestinal hyperabsorption of calcium. Although patients with uric acid calculi constitute only a small fraction of those in whom stones form, they represent a group in whom good medical therapy, based on sound physiologic principles, has proved extremely successful. Renal tubular syndromes lead to nephrocalcinosis and lithiasis through hypercalciuria, alkaline urine and hypocitraturia, the latter an inhibitor of calcium salt precipitation. Recent advances in surgical techniques are discussed, including the rationale for removing staghorn calculi. The ileal ureter and coagulum pyelolithotomy deserve special emphasis.     

Activation of liver X receptor suppresses osteopontin expression and ameliorates nephrolithiasis

Nephrolithiasis is a common disease of the urinary system, of which idiopathic calcium oxalate (CaOx) kidney stones, in particular, are one of the special types. In the initial stages of CaOx kidney stone formation, Randall's plaques (RPs) develop. Liver X receptors (LXRs) inhibit oxidative stress and inflammatory in other diseases; nevertheless, the role of LXRs in nephrolithiasis has yet to be elucidated. In this study, the role of LXRs in the progression of RP formation was investigated. Microarray analysis revealed that LXR/RXR levels were significantly greater in low-plaque tissues (<5%) than in high-plaque tissues (>5%), confirming the link between LXR activation and RP formation. Correspondingly, expression levels of two LXR target genes, LXRα and LXRβ, were lower in high-plaque tissues than in low-plaque tissues. In vitro, LXR agonist alleviated calcium oxalate monohydrate-induced cellular calcium deposits and apoptosis. LXR activation decreased reactive oxygen species production and gene expression of inflammatory mediators, including osteopontin that has recently been demonstrated to correlate with the development of RPs. Moreover, p38 MAPK and JNK signaling may mediate LXR-regulated expression in HK-2 cells. In an animal model, the deposition was reduced by activating LXR, and osteopontin expression was also inhibited. Our findings suggest a role for LXRs in the progression of idiopathic CaOx kidney stones; LXR agonists may have therapeutic potential for the treatment of nephrolithiasis.     

Diversity in Protein Profiles of Individual Calcium Oxalate Kidney Stones

Calcium oxalate kidney stones contain low amounts of proteins, some of which have been implicated in progression or prevention of kidney stone formation. To gain insights into the pathophysiology of urolithiasis, we have characterized protein components of calcium oxalate kidney stones by proteomic approaches. Proteins extracted from kidney stones showed highly heterogeneous migration patterns in gel electrophoresis as reported. This was likely to be mainly due to proteolytic degradation and protein-protein crosslinking of Tamm-Horsfall protein and prothrombin. Protein profiles of calcium oxalate kidney stones were obtained by in-solution protease digestion followed by nanoLC-MALDI-tandem mass spectrometry, which resulted in identification of a total of 92 proteins in stones from 9 urolithiasis patients. Further analysis showed that protein species and their relative amounts were highly variable among individual stones. Although proteins such as prothrombin, osteopontin, calgranulin A and calgranulin B were found in most stones tested, some samples had high contents of prothrombin and osteopontin, while others had high contents of calgranulins. In addition, calgranulin-rich stones had various neutrophil-enriched proteins such as myeloperoxidase and lactotransferrin. These proteomic profiles of individual kidney stones suggest that multiple systems composed of different groups of proteins including leucocyte-derived ones are differently involved in pathogenesis of individual kidney stones depending on situations.     

Association of Parathyroidectomy With 5-Year Clinically Significant Kidney Stone Events in Patients With Primary Hyperparathyroidism

ObjectivePatients with primary hyperparathyroidism (PHPT) are at increased risk of kidney stones. Guidelines recommend parathyroidectomy in patients with PHPT with a history of stone disease. This study aimed to compare the 5-year incidence of clinically significant kidney stone events in patients with PHPT treated with parathyroidectomy versus nonoperative management.MethodsWe performed a longitudinal cohort study of patients with PHPT in a national commercial insurance claims database (2006-2019). Propensity score inverse probability weighting-adjusted multivariable regression models were calculated.ResultsWe identified 7623 patients aged ≥35 years old with continuous enrollment >1 year before and >5 years after PHPT diagnosis. A total of 2933 patients (38.5%) were treated with parathyroidectomy. The cohort had a mean age of 66.5 years, 5953 (78.1%) were female, and 5520 (72.4%) were White. Over 5 years, the unadjusted incidence of ≥1 kidney stone event was higher in patients who were managed with parathyroidectomy compared with those who were managed nonoperatively overall (5.4% vs 4.1%, respectively) and among those with a history of kidney stones at PHPT diagnosis (17.9% vs 16.4%, respectively). On multivariable analysis, parathyroidectomy was associated with no statistically significant difference in the odds of a 5-year kidney stone event among patients with a history of kidney stones (odds ratio, 1.03; 95% CI, 0.71-1.50) or those without a history of kidney stones (odds ratio, 1.16; 95% CI, 0.84-1.60).ConclusionBased on this claim analysis, there was no difference in the odds of 5-year kidney stone events in patients with PHPT who were treated with parathyroidectomy versus nonoperative management. Time horizon for benefit should be considered when making treatment decisions for PHPT based on the risk of kidney stone events.     

Gastrin-releasing peptide receptor gene silencing inhibits the development of the epithelial–mesenchymal transition and formation of a calcium oxalate crystal in renal tubular epithelial cells in mice with kidney stones via the PI3K/Akt signaling pathway

Between 1% and 15% of people are globally affected by kidney stones, and this disease has become more common since the 1970s. Therefore, this study aims to investigate the effects of gastrin-releasing peptide receptor (GRPR) gene silencing via the PI3K/Akt signaling pathway on the development of the epithelial–mesenchymal transition (EMT) and formation of a calcium oxalate crystal in renal tubular epithelial cells (TECs) of kidney stones. A total of 70 clean and healthy C57BL/6J mice were assigned into the normal ( n = 10) and kidney stones groups ( n = 60). The underlying regulatory mechanisms of GRPR were analyzed in concert with the treatment of shGRPR-1, LY294002, and shGRPR-1 + LY294002 in TECs isolated from mice with kidney stones. A series of experiments were conducted for the measurement of urinary oxalate and urinary calcium, the renal calcium salt deposition, the positive rate of GRPR, the expressions of renal TECs related genes and calcium oxalate regulation related genes, and the growth of calcium crystals induced by cells. After treatment of shGRPR-1 and shGRPR-1 + LY294002, levels of urinary oxalate and urinary calcium in the serum, as well as positive rate of GRPR, became relatively low, levels of E-cadherin enhanced, whereas levels of Akt, PI3K, GRPR, extents of PI3K and Akt phosphorylation, α-SMA, Vimentin and FSP-1, OPN, MCP-1, and CD44 decreased and a number of crystals reduced. Taken together, we conclude that GRPR gene silencing suppresses the development of the EMT and formation of the calcium oxalate crystal in renal TECs of kidney stones through the inactivation of the PI3K/Akt signaling pathway.     

Peeping into Human Renal Calcium Oxalate Stone Matrix: Characterization of Novel Proteins Involved in the Intricate Mechanism of Urolithiasis

Background

The increasing number of patients suffering from urolithiasis represents one of the major challenges which nephrologists face worldwide today. For enhancing therapeutic outcomes of this disease, the pathogenic basis for the formation of renal stones is the need of hour. Proteins are found as major component in human renal stone matrix and are considered to have a potential role in crystal–membrane interaction, crystal growth and stone formation but their role in urolithiasis still remains obscure.

Methods

Proteins were isolated from the matrix of human CaOx containing kidney stones. Proteins having MW>3 kDa were subjected to anion exchange chromatography followed by molecular-sieve chromatography. The effect of these purified proteins was tested against CaOx nucleation and growth and on oxalate injured Madin–Darby Canine Kidney (MDCK) renal epithelial cells for their activity. Proteins were identified by Matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF MS) followed by database search with MASCOT server. In silico molecular interaction studies with CaOx crystals were also investigated.

Results

Five proteins were identified from the matrix of calcium oxalate kidney stones by MALDI-TOF MS followed by database search with MASCOT server with the competence to control the stone formation process. Out of which two proteins were promoters, two were inhibitors and one protein had a dual activity of both inhibition and promotion towards CaOx nucleation and growth. Further molecular modelling calculations revealed the mode of interaction of these proteins with CaOx at the molecular level.

Conclusions

We identified and characterized Ethanolamine-phosphate cytidylyltransferase, Ras GTPase-activating-like protein, UDP-glucose:glycoprotein glucosyltransferase 2, RIMS-binding protein 3A, Macrophage-capping protein as novel proteins from the matrix of human calcium oxalate stone which play a critical role in kidney stone formation. Thus, these proteins having potential to modulate calcium oxalate crystallization will throw light on understanding and controlling urolithiasis in humans.     

Plasma levels and urinary excretion of amino acids by subjects with renal calculi

Plasma levels and urinary amino acid excretions were estimated by high-performance liquid chromatography in 15 control subjects and 36 stone formers (SFs) classified according to the stone type: (1) 22 cases with calcium oxalate stones; (2) four cases with pure uric acid stones; (3) 10 cases with magnesium-ammonium phosphate stones, either pure or mixed with apatite. Some types of stones (namely oxalate and uric acid calculi) are mainly formed as a result of a metabolic deficiency that may affect the amino acid metabolism, and thus may be reflected in the urinary amino acid pattern. Data demonstrated clearly that there is a general tendency towards decreased amino acid excretions in all SFs with all types of stones. As a whole, one can observe a higher percentage of patients with calcium oxalate and phosphate calculosis, who have low urine excretions of amino acids; about 50% are the SFs with lower urine excretion of serine, glycine, taurine and i-leucine; the high percentage of patients with CaOX calculi shows lower urine excretions of tyrosine and ornithine.