HIV阳性患者合并上尿路结石的单中心诊疗经验并结石成分分析  

Single center diagnosis and treatment experience of HIV positive patients with upper urinary tract stones and analysis of stone components

作　　者：吴梦华 张愚[1] 郑鑫[1] Wu Menghua;Zhang Yu;Zheng Xin(Department of Urology,Beijing Youan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京佑安医院泌尿外科,100069

出　　处：《北京医学》2022年第3期227-231,共5页Beijing Medical Journal

摘　　要：目的探讨HIV阳性患者合并上尿路结石的术后情况及相关结石成分分析。方法收集2013年1月至2019年1月首都医科大学附属北京佑安医院收治的上尿路结石患者101例,根据是否合并HIV感染分为HIV阳性组(32例)和HIV阴性组(69例),记录BMI、血钙、尿酸(uric acid,UA)、结石位置、手术方式及术后感染发生率等,通过手术方式获取结石样本后,对结石组成进行分析。结果HIV阳性组和HIV阴性组手术相关指标,如手术时间,住院时间和术后感染中毒性休克发生率比较,差异均无统计学意义(P>0.05),HIV阳性组血清UA明显高于HIV阴性组[(349.06±95.95)μmol/L比(306.70±85.29)μmol/L,P=0.028]。结石总体组成评估显示,HIV阳性组二水草酸钙(calcium oxalate dihydrate,CaODH)比例较HIV阴性组高[(21.4±22.4)%比(8.5±11.9)%],差异有统计学意义(P<0.001);两组一水草酸钙(calcium oxalate monohydrate,CaOMH)和UA结石情况比较,差异无统计学意义(P>0.05)。结论已进行抗反转录病毒治疗(anti-retroviral therapy,ART)的HIV阳性患者进行结石手术并不会增加术后感染风险,HIV阳性患者的CaODH结石发生率可能更高,目前的一线ART方案并不会增加药物结石的风险。Objective To investigate the postoperative situation and related stone components of HIV positive patients with upper urinary tract stones.Methods A total of 101 patients with upper urinary tract stones admitted to Beijing Youan Hospital,Capital Medical University from January 2013 to January 2019 were collected.The patient were divided into HIV-positive group(32 cases)and HIV-negative group(69 cases)according to whether they were combined with HIV infection.BMI,uric acid(UA),stone location,operation method and incidence of postoperative infection were recorded.After obtaining stone samples by operation,the stone composition was analyzed.Results There were no significant differences in surgical related indicators,such as operation time,hospital stay and the incidence of postoperative infection and toxic shock between HIV-positive group and HIV-negative group(P>0.05).Serum UA in HIV-positive group was significantly higher than that in HIV-negative group[(349.06±95.95)μmol/L vs.(306.70±85.29)μmol/L,P=0.028].The assessment of stone composition showed that the proportion of calcium oxalate dihydrate(CaODH)in the HIV-positive group was higher than in the HIV-negative group[(21.4±22.4)%vs.(8.5±11.9)%],the difference was statistically significant(P<0.001).There was no significant difference in calcium oxalate monohydrate(CaOMH)and UA stones between the two groups(P>0.05).Conclusions Stone surgery in HIV positive patients who have received anti-retroviral therapy(ART)will not increase the risk of postoperative infection.The incidence of CaODH stones in HIV positive patients may be higher.The current first-line ART scheme will not increase the risk of drug stones.

关 键 词：上尿路结石 人类免疫缺陷病毒 结石成分 

分 类 号：R691.4[医药卫生—泌尿科学] R512.91[医药卫生—外科学]