Composition and morphology of phosphate stones and their relation with etiology
Composition and morphology of phosphate stones and their relation with etiology
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DOI：
10.1007/s00240-010-0320-3
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发表时间：
2010-12-01
影响因子：
--
通讯作者：
Bazin, Dominique
中科院分区：
文献类型：
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作者：
Daudon, Michel;Bouzidi, Hassan;Bazin, Dominique
磷酸钙（CaP）结石约占所有泌尿系结石的15%，女性占明显优势，反映了病因的广泛多样性。CaP尿石症的相对患病率随时间的变化存在争议，CaP结石分析与病因诊断的相关性被低估甚至否定。基于对过去三十年中超过50，000个结石的分析，我们评估了1980-1989年（第1阶段）和2000-2009年（第2阶段）之间CaP结石相对比例的变化。此外，我们使用形态学检查结合傅立叶变换红外分析，评估CaP结石分析与病因因素之间的关联。在第1阶段和第2阶段之间，无鸟粪石结石的总体比例基本保持不变（11.6 vs. 11.1%），碳磷灰石结石的比例下降（10.6 vs. 8.4%，p < 0.001），透钙磷石结石的比例上升（0.8 vs. 2.2%，p < 0.001）。高钙尿症与87%透钙磷石和60%碳磷灰石结石有关。尿路感染与少量鸟粪石和/或碳磷灰石碳酸化率> 15%有关。在与原发性甲状旁腺功能亢进相关的CaP结石中，主要成分为66.9%的碳磷灰石和29.1%的透钙磷石。远端肾小管酸中毒总是与碳磷灰石结石有关，表现出一种特殊的，实际上是特异性的形态。总之，综合分析结石的形态学检查是临床相关的，以改善病因评估患者的前列腺结石。
Calcium phosphate (CaP) stones account for about 15% of all urinary stones, with a marked female preponderance, and reflect a wide diversity of etiology. Variation of the relative prevalence of CaP urolithiasis over time is disputed, and relevance of CaP stone analysis for etiologic diagnosis is underestimated or even negated. Based on the analysis of more than 50,000 stones over the past three decades, we evaluated the changes in the relative proportion of CaP stones between 1980-1989 (period 1) and 2000-2009 (period 2). In addition, using morphologic examination combined with Fourier-transform infrared analysis, we assessed the associations between CaP stone analysis and etiopathogenic factors. Between periods 1 and 2, the overall proportion of struvite-free stones remained essentially unchanged (11.6 vs. 11.1%), with a decreasing proportion of carbapatite stones (10.6 vs. 8.4%, p < 0.001) and a rising proportion of brushite stones (0.8 vs. 2.2%, p < 0.001). Hypercalciuria was associated with 87% of brushite, and 60% of carbapatite stones. Urinary tract infection was associated with presence of minor amounts of struvite and/or with a carbonation rate of carbapatite > 15%. In CaP stones associated with primary hyperparathyroidism, the main component was carbapatite in 66.9% and brushite in 29.1% of cases. Distal renal tubular acidosis was always associated with carbapatite stones exhibiting a peculiar, virtually pathognomonic, morphology. In conclusion, comprehensive analysis of stones involving morphologic examination is of clinical relevance for improved etiologic evaluation of patients with CaP urolithiasis.