复发性尿结石患者支原体检测和尿石成分分析的临床价值探讨  

Analysis of Mycoplasma Detection and Constituents of Urinary Stones in Patients with Recurrent Urolithiasis

作　　者：帅丽华[1] 冷耀明[1] 周会祥[1] 孙晓红[1] 何媛[1] 曾泉[2] 宋秋元[2] 

机构地区：[1]九江学院附属医院检验科,江西九江332000 [2]九江学院附属医院泌尿外科,江西九江332000

出　　处：《现代检验医学杂志》2010年第1期64-66,共3页Journal of Modern Laboratory Medicine

基　　金：九江市科学技术局立项课题：九科字[2008]91-10.

摘　　要：目的探讨复发性尿结石患者结石形成初期解脲支原体（UU）感染状况及其与结石复发形成的关系。方法采用实时荧光定量PCR法（FQ—PCR）对上尿路结石52例、下尿路结石121例的早期尿结石即尿结石中的核心部分-石核进行解脲支原体核酸成分（UU—DNA）检测，同时用化学滴定法分析石核的化学成分。结果复发性尿结石发病男性多于女性，30～65岁多发，52例复发性上尿路结石的石核中UU—DNA阳性者4例，阳性率为7．7％，121例复发性下尿路结石的石核中UU—DNA阳性者36例，阳性率为29．8％，二者比较差异有统计学极显著性意义（x^2=9.96，P〈0．005）。UU—DNA阳性石核的化学成分中均含有碳酸钙和（或）磷酸钙盐、镁盐或碳酸磷灰石，UU—DNA阴性石核的化学成分中以草酸钙为主。对40例石核UU—DNA阳性患者取石后随防2年结果显示：对UU进行治疗的研究组取石后2年内尿结石的再复发率为1／20，而未对UU进行治疗的对照组再复发率为13／20，二组患者取石后2年内的再复发率差异有统计学极显著性意义（x^2=15．82，P〈0．005）。结论尿结石的石核中检测到UU—DNA是尿结石复发形成初期感染UU的直接证据，且UU—DNA阳性石核中均含有碳酸钙或磷酸钙等UU活动时产生的化学成分，说明尿结石形成早期，尿路有UU感染活动的迹象；取石后随访2年的结果：控制UU感染可极显著地降低石核UU—DNA阳性者的结石复发率，证明UU感染是石核UU—DNA阳性者结石复发形成的最主要因素。Objective To analyze the relationship of mycoplasma （U. urealyticum UU） infection in urolithiasis beginning period and recurrence of urinary stones in patients with recurrent urolithiasis. Methods Real-time fluorescence quantitative-PCR （FQ-PCR） for UU nucleic acid composition （UU-DNA） testing,and chemical titration analysis were concurrently carried out on 173 random samples,which were early urinary stones （the central part of urinary stone-stone Cores） collected from 52 cases of upper system stones and 121 cases of lower system stones. Results Recurrent urolithiasis were often found in males than in females ,especially in the range of 30 to 65 years of age. 4 cases were found to UU-DNA positive in 52 upper system stones（7.7%）,and 36 cases positive in 121 lower system stones（29. 8%）,there was a very significant difference between the two （x^2= 9.96,P〈0. 005）. Calcium carbonate or magnesium, phosphate calcium or carbonic acid apatite were found in all UU-DNA-positive stone cores,and calcium oxalate were found in most of UU-DNA-negative stone cores. During the two-year follow-up,after 40 UU-DNA-posltive urolites being taken away,found in research group treated on UU recurrence rate of urinary stones was 1/20 in 2 years after taking stone,while in control group untreated on UU recurrence rate was 13/20,and then it was a very significant difference in recurrence rate （x^2= 15.82 ,P〈0. 005）. Conclusion UU-DNA coming from stone cores is the direct evidence of the initial infection by UU in Urolithiasis,and calcium carbonate or phosphate etc. Chemical constituents caused by UU infection was found in UU-DNA-positive stones cores,explain urinary system was infected by UU in the earlist Urolithiasis. The results of follow-up after 2 years shown,treatment of UU infection may significantly reduce recurrence rate of stones,prove that UU infection is the most important factor of recurrence of Urolites with UU-DNA-positive stone cores.

关 键 词：复发性尿结石 石核 解脲支原体核酸 聚合酶链反应 

分 类 号：R691.4[医药卫生—泌尿科学] R446.12[医药卫生—外科学]