We aimed to investigate the diagnostic value of urinary Tamm-Horsfall protein (THP) and 24 h urine osmolality for recurrent calcium oxalate (CaOx) stones. Clinical data of 120 patients with upper urinary tract stones admitted to our hospital between January 2020 and January 2022 were retrospectively reviewed. Patients were divided into recurrence (53 patients) and non-recurrence (67 patients) groups based on postoperative stone recurrence. Meanwhile, 50 healthy patients were selected as the control group. Urinary THP levels, 24 h urine osmolality, and biochemical indices were compared between the three groups; their diagnostic values for stone recurrence were evaluated using receiver operating characteristic (ROC) curves. Urinary THP, 24 h urine osmolality, and biochemical indices were significantly higher in the recurrence group than in the non-recurrence and control groups (P < 0.05). The 24 h urine osmolality was positively correlated with urinary oxalic acid and calcium excretion. ROC curve analysis showed that optimal cutoff values of urinary THP and 24 h urine osmolality for the diagnosis of stone development were ≥27.01 mg/L and ≥577.69 mOsm/(kg H2O), respectively. Furthermore, these indices combined significantly improved the accuracy of diagnosis. Urinary THP and 24 h urine osmolality were higher in patients with recurrent CaOx stones. Detection of both parameters combined can accurately diagnose stone recurrence.

目的 分析上海松江地区肾结石患者结石培养和术前尿培养结果的临床特点以及与其术后感染的关系.方法 回顾性分析上海交通大学医学院附属松江医院2020年1月—2022年6月收住入院的213例肾结石患者资料,所有患者行术前清洁中段尿培养、药敏实验及结石培养,并分析不同性别患者的细菌差异,结石/细菌培养阳性者与阴性者术后发生感染的差异性.结果 213例肾结石患者中,尿培养阳性者47例(22.1％),其中大肠埃希菌最为常见[20株(42.6％)].女性患者中大肠埃希菌比例显著高于男性患者[12株(48.0％)v s.8株(36.4％),P<0.05],而男性患者中肺炎克雷伯杆菌比例显著高于女性[5株(22.7％)vs.3株(12.0％),P<0.05],药敏结果显示:主要的革兰阴性菌对氨卞西林/舒巴坦、头孢唑啉、头孢呋辛等耐药性较高,而对亚胺培南、卡那霉素、哌拉西林/他唑巴坦等敏感性较高;主要的革兰阳性菌对克林霉素、红霉素、左氧氟沙星耐药性较高,而对万古霉素、替考拉宁、利奈唑胺敏感性较高.结石培养阳性者31例(14.6％),最常见的细菌分别为:奇异变形菌9株(29.0％).而男性与女性患者在主要细菌谱上未见明显差异.术后发生发热/尿源性脓毒血症者中尿培养/结石培养阳性者比例明显高于阴性者(P<0.05).结论 上海松江地区肾结石患者尿液菌谱以大肠杆菌为主,并且与结石培养结果差异性较大,临床上应加强结石培养等病原学检测,合理使用抗生素,降低术后感染的发生.

Abstract Introduction: To investigate the predictive value of urinary Tamm-Horsfall protein (THP) and 24-h urine osmolality for recurrence in patients with calcium oxalate (CaOx) stones. Methods: The clinical data of 120 patients hospitalized for upper urinary tract stones between January 2020 and January 2022 in our hospital were retrospectively reviewed. Patients with and without stone recurrence at postoperative follow-up were divided into a recurrence group (53 patients) and a non-recurrence group (67 patients); 50 healthy patients during the same period were selected as the control group. Levels of urinary THP, 24-h urine osmolality, and biochemical indices were then compared between the three groups. Receiver operating characteristic (ROC) curves were applied to predict the predictive values of urinary THP and 24-h urine osmolality for stone recurrence. Results: Urinary THP, 24-hour urine osmolality, and biochemical indices in the recurrence group were significantly higher than those in the non-recurrence group and the control group (P < 0.05). 24-h urine osmolality was positively correlated with urinary oxalic acid and calcium excretion. ROC curve analysis showed that the optimal cut-off values for urinary THP and 24-h urine osmolality for the prediction of stone development were ≥27.01mg/L and ≥577.69mOsm/(kg·H2O); furthermore, the combination of these indices significantly improved the accuracy of prediction. Conclusion: Urinary THP and 24-hour urine osmolality are higher in patients with recurrent CaOx stones; the combined detection of these parameters can accurately predict stone recurrence.

肾结石的发病率很高，是泌尿外科的常见疾病之一[1]。最常见的结石成分是以钙盐为基础[2]。肾结石的形成受遗传和环境因素的影响[3-4]。饮食习惯属于后者，饮食因素可导致尿成分异常等[5]，而较高的尿钙排泄是肾结石形成的重要危险因素[6]。因此，对钙盐结石者的营养建议包括增加液体、蔬菜和水果的摄入，平衡钙摄入，减少钠和动物蛋白的摄入等[7]。考虑到钙的吸收导致结石患者尿钙水平增加，理论上补充维生素D可能会增加钙的吸收和结石形成。虽然现有的关于膳食钙摄入的文献都支持钙饮食增加结石形成风险，但关于维生素D摄入和钙补充的数据不太一致[8-9]。因此，本研究旨在综述钙和维生素D与肾结石形成关系的研究现状及进展，为相关研究提供参考。

目的 探讨N-乙酰半胱氨酸(NAC)对纳米细菌致大鼠肾结石形成的影响.方法 将45只健康SD雄性大鼠预饲养后随机分为A、B、C 3组.B组和C组尾静脉注射纳米细菌混悬液1 mL制备大鼠肾结石模型,A组大鼠尾静脉注射等量生理盐水.C组于第2日腹腔注射NAC[150 mg/(kg·d)]进行干预,同时A组和B组腹腔注射等量生理盐水,每天1次,连续干预4周后收集24 h尿液.检测尿液Ca2+、草酸钙(Oxa)的含量;处死大鼠取左肾制成10％ 匀浆检测丙二醛(MDA)、超氧化物歧化酶(SOD)水平;取右肾行HE染色,观察组织的病理变化并进行钙盐结晶量化评分.结果 与A组相比,B组肾脏组织中钙盐结晶积分较高,尿Ca2+、Oxa及肾组织中MDA水平较高,而肾组织SOD水平较低(P<0.05),HE染色显示肾小管内可见大量结晶形成;与B组相比,C组肾脏组织中钙盐结晶积分较低,尿Ca2+、Oxa及肾组织中MDA水平均较低,肾组织SOD水平较高(P<0.05),HE染色显示肾小管内晶体沉积减少.结论 NAC可能通过减轻氧化应激,抑制肾脏组织中钙盐结晶的形成.

目的 评估输尿管软镜碎石术(RIRS)和经皮肾镜碎石术(PCNL)中影响患者治疗偏好的因素.方法 回顾性分析上海交通大学医学院附属松江医院,因肾结石需行手术治疗的120例中等大小(直径15～20 m m)结石患者,对其进行问卷调查,评估与RIRS和PCNL相关的4种治疗属性[总住院时间、术后残石率、有无手术创面、术后尿路感染(UTI)风险]的重要性,并采用联合分析法分析各属性的相对重要性.按年龄将患者分为<60岁组、≥60岁组,并比较两组间治疗偏好的差异.结果 120例患者在治疗中等大小结石时,采用RIRS(53.3％)和PCNL(46.7％)的概率几乎相同(P>0.05).4种相关属性的相对重要性从大到小依次为:术后残石率(42.5％)、有无手术切口(25.3％)、总住院时间(17.6％)、术后U T I(14.6％).<60岁组更倾向于选择RIRS(31.7％),其主要考虑因素为术后残石率(40.12％)和有无手术创面(30.58％);≥60岁的患者认为较低的术后残石率(45.99％)和总住院时间(20.99％)更为重要,倾向于选择PCNL(28.4％).结论 在中等大小肾结石的治疗中,患者使用RIRS或PCNL的倾向几乎相同,<60岁的患者更在意有无手术创面,倾向于选择RIRS;≥60岁的患者认为总住院时间较为重要,倾向于选择PCNL.

Objective:To explore the effects of dark plum extract on the expression of Tamm-Horsfall(THP) protein in rats with nanobacteria-induced kidney stones.Methods:From September 2016 to September 2017, forty-five SD male rats were randomly divided into control group, model group and observation group, with 15 cases in each group.Rat kidney stone model was prepared by injecting 1 mL of nanobacteria suspension into the tail vein of model group and observation group, and control group was injected with the same amount of normal saline in the tail vein.Observation group was intragastrically administrated 2 mL of dark plum extract(0.15 g/mL) on the 2nd, and model group and control group were given the same amount of normal saline.After 4 weeks of continuous intervention, 24 hours urine was collected in a metabolic cage. The contents of Ca 2+, citric acid(CA) and oxalic acid(Oxa) in urine were detected.The expression of THP protein in urine was determined by ELISA kit. HE staining was performed on kidney tissues, and the pathological changes of tissues, the morphology of calcium salt and the amount of crystallization in kidney tissues were observed, and the calcium salt crystal quantitative score was performed. Results:Compared with control group, the calcium salt crystallization score in kidney tissues in model group was significantly increased( P<0.05), and the pH value and CA level in urine were significantly decreased( P<0.05), and the Ca 2+ and Oxa levels and THP protein expression were significantly elevated( P<0.05). Compared with model group, the calcium salt crystallization score in kidney tissues in observation group was significantly decreased( P<0.05), and the PH value and CA level in urine were significantly increased( P<0.05), and the Ca 2+ and Oxa levels and THP protein expression were decreased significantly( P<0.05). HE staining showed a decrease in renal tubular crystal deposition. Conclusions:Dark plum extract may inhibit the formation of calcium oxalate crystals in kidney tissues by reducing the expression of THP protein and self-polymerization in rats with nanobacteria-induced kidney stones.

肾结石是泌尿系疾病中的常见疾病,其发病率和复发率在不断上升.随着人们对于肾结石研究的深入,发现其与代谢综合征有着密切联系.而肥胖作为代谢综合征中的一个重要组成部分,引起了学者们的注意并将其和肾结石共同进行了研究,旨在通过研究两者关系从而降低肾结石发病率.本文拟就肥胖与肾结石的研究进展作一综述.