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北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (6): 1134-1140. doi: 10.19723/j.issn.1671-167X.2022.06.013

• 论著 • 上一篇    下一篇

尿枸橼酸定量检测在原发性痛风患者肾结石诊断中的应用价值

王昱1,张慧敏2,邓雪蓉1,刘伟伟3,陈璐4,赵宁5,张晓慧1,宋志博1,耿研1,季兰岚1,王玉2,张卓莉1,*()   

  1. 1. 北京大学第一医院风湿免疫科，北京 100034
    2. 北京大学第一医院肾内科，北京 100034
    3. 河北省沧州市渤海新区中捷医院综合内科，河北沧州 061108
    4. 北京航空总医院中医科，北京 100012
    5. 北京中医药大学附属护国寺中医医院针灸科，北京 100035
  • 收稿日期:2022-08-10 出版日期:2022-12-18 发布日期:2022-12-19
  • 通讯作者: 张卓莉 E-mail:zhuoli.zhang@126.com
  • 基金资助:
    国家自然科学基金(81501400);中央高水平医院临床科研业务费专项(北京大学第一医院院内交叉临床研究专项)(2022CR10)

Diagnostic values of urinary citrate for kidney stones in patients with primary gout

Yu WANG1,Hui-min ZHANG2,Xue-rong DENG1,Wei-wei LIU3,Lu CHEN4,Ning ZHAO5,Xiao-hui ZHANG1,Zhi-bo SONG1,Yan GENG1,Lan-lan JI1,Yu WANG2,Zhuo-li ZHANG1,*()   

  1. 1. Department of Rheumatology and Immunology, Peking University First Hospital, Beijing 100034, China
    2. Department of Nephrology, Peking University First Hospital, Beijing 100034, China
    3. Department of Internal General Medicine, Zhongjie Hospital, Cangzhou 061108, Hebei, China
    4. Department of Traditional Chinese Medicine, Aviation General Hospital of China Medical University, Beijing 100012, China
    5. Department of Acupuncture, Huguosi Traditional Chinese Medicine Hospital affiliated to Beijing University of Chinese Medicine, Beijing 100035, China
  • Received:2022-08-10 Online:2022-12-18 Published:2022-12-19
  • Contact: Zhuo-li ZHANG E-mail:zhuoli.zhang@126.com
  • Supported by:
    National Natural Science Foundation of China(81501400);National High Level Hospital Clinical Research Funding(Interdepartmental Clinical Research Project of Peking University First Hospital)(2022CR10)

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摘要：

目的: 分析原发性痛风患者24 h尿液离子含量及其与肾结石的关系，探讨其在痛风合并肾结石诊断中的价值。方法: 回顾性分析2020年1月至2021年5月在北京大学第一医院风湿免疫科门诊连续就诊且资料完整的痛风患者，根据临床和超声资料，分析肾结石与尿液离子成分的相关性以及肾结石形成的危险因素。进一步以双能CT证实的肾尿酸盐结石为金标准，探讨尿液离子异常对于痛风合并肾尿酸盐结石的诊断价值。结果: 100例患者中80例超声发现下肢关节尿酸盐晶体沉积，61例超声发现肾结石，34例双能CT检查证实为尿酸盐结石。与超声检查无肾结石组患者相比，肾结石组的痛风病程更长[(48.7±26.6)个月vs. (84.0±30.6)个月，P=0.01]，24 h尿草酸总量更高[(20.1±9.6) mg vs. (28.6±20.7) mg，P=0.001]，24 h尿枸橼酸总量更低[(506.3±315.4) mg vs. (355.7±219.6) mg，P=0.001]。与双能CT无肾结石组患者相比，肾尿酸盐结石组痛风病程更长[(49.1±28.4)个月vs. (108.3±72.2)个月，P=0.001]，24 h尿草酸总量更高[(23.6±16.9) mg vs. (28.5±18.8) mg，P < 0.05]，24 h尿枸橼酸总量更低[(556.0±316.3) mg vs. (391.7±261.2) mg，P < 0.05]，平均血尿酸水平及24 h尿尿酸总量更高[(466.2±134.5) μmol/L vs. (517.2±18.1) μmol/L，P < 0.05；(1 518.1±893.4) mg vs. (1 684.2±812.1) mg，P < 0.05]。以病程、既往痛风发作频率、血尿酸、血肌酐及24 h尿草酸、枸橼酸、尿酸为自变量进行Logistic回归分析，结果显示长病程(OR=1.229，95%CI：1.062~1.522，P < 0.05)、高血尿酸(OR=1.137，95%CI：1.001~1.213，P=0.01)、低24 h尿枸橼酸总量(OR=0.821，95%CI：0.659~0.952，P=0.01)为痛风患者超声发现肾结石的危险因素；长病程(OR=1.201，95%CI：1.101~1.437，P=0.005)、高血肌酐(OR=1.145，95%CI：1.001~1.182，P=0.04)、低24 h尿枸橼酸总量(OR=0.837，95%CI：0.739~0.931，P=0.02)为痛风患者出现肾尿酸盐结石的危险因素。结论: 长病程、低24 h尿枸橼酸的痛风患者更容易出现肾结石。

关键词: 痛风, 肾结石, 枸橼酸, 超声检查, 双能电子计算机断层扫描

Abstract:

Objective: To evaluate the relationship between 24 h urinary ion content and kidney stones, and to explore the diagnostic values of kidney stone in primary gout patients. Methods: Patients diagnosed with primary gout had ultrasound scanning of both feet and kidneys in Peking University First Hospital from Jan. 2020 to May 2021. Their clinical characteristics were compared between the positive and negative kidney stone groups, and the relationship between kidney stone and urinary ion composition were analyzed. Risk factors of kidney stone were analyzed. The explored diagnostic values were evaluated for urinary oxalate and citrate according with uric acid kidney stones by dual-energy computed tomography (DECT). Results: Among the 100 gouty patients, 80 patients had uric acid crystal deposition in lower joints of extremity by ultrasonography, 61 patients had kidney stone, and 34 had kidney uric acid stones by DECT. All the multiple kidney stones were proved as uric acid kidney stones by DECT. Compared with patients without kidney stone group proved by ultrasonography, patients with kidney stone had longer gouty duration [(48.7±26.6) months vs. (84.0±30.6) months, P=0.01], higher 24 h urinary oxalate [(20.1±9.6) mg vs. (28.6±20.7) mg, P=0.001] and lower 24 h urinary citrate [(506.3±315.4) mg vs. (355.7±219.6) mg, P=0.001]. Compared with the patients without kidney stone by DECT, the patients with uric acid kidney stone also had longer disease duration [(49.1±28.4) months vs. (108.3±72.2) months, P=0.001], higher 24 h urinary oxalate [(23.6±16.9) mg vs. (28.5±18.8) mg, P < 0.05], lower 24 h urinary citrate [(556.0±316.3) mg vs. (391.7±261.2) mg, P < 0.05], higher serum uric acid [(466.2±134.5) μmol/L vs. (517.2±18.1) μmol/L, P < 0.05] and higher 24 h urinary uric acid [(1 518.1±893.4) mg vs. (1 684.2±812.1) mg, P < 0.05]. Logistic regression analysis showed long gout disease duration (OR=1.229, 95%CI: 1.062-1.522, P < 0.05), high serum uric acid level (OR=1.137, 95%CI: 1.001-1.213, P=0.01), low 24 h urinary citrate (OR=0.821, 95%CI: 0.659-0.952, P=0.01) were all risk factors of kidney stones by ultrasonography. Also, long gout disease duration (OR=1.201, 95%CI: 1.101-1.437, P=0.005), high serum creatine uric level (OR=1.145, 95%CI: 1.001-1.182, P=0.04), low 24 h urinary citrate (OR=0.837, 95%CI: 0.739-0.931, P=0.02) were all risk factors of kidney uric acid stones by DECT. Conclusion: Long disease duration and low 24 h urinary citrate were risk factors for kidney stones.

Key words: Gout, Kidney stone, Citrate, Ultrasonography, Dual-energy computed tomography

中图分类号: 

  • R589.7

表1

超声探测肾结石阳性组和阴性组痛风患者的临床特征比较"

Items Positive kidney stone by US (n=61) Negative kidney stone by US (n=39) P
Age/years 43.5±9.0 42.8±11.0 0.992
Disease duration/months 84.0±30.6 48.7±26.6 0.01
Gout flare frequency/years 4 (1, 10) 1 (1, 2) 0.05
BMI/(kg/m2) 27.8±3.4 27.2±3.3 0.396
Serum uric acid/(μmol/L) 513.1±128.0 480.4±103.4 0.001
Serum creatinine/(μmol/L) 93.7±14.8 83.4±17.7 0.004
eGFR/(mL/min) 87.4±15.1 97.9±16.6 0.002
hsCRP/(mg/L) 13.8±4.2 12.8±3.2 0.601
Glucose/(mmol/L) 2.4±3.0 3.3±2.6 0.301
TG/(mmol/L) 2.1±1.1 3.2±2.5 0.036
TCHO/(mmol/L) 4.5±1.4 4.6±0.9 0.838
LDL-C/(mmol/L) 2.6±0.9 2.5±0.8 0.549
Urinary oxalic acid/(mg/L) 15.0±8.0 8.3±3.6 0.001
Urinary oxalic acid/(mg/24 h) 28.6±20.7 20.1±9.6 0.006
Urinary citrate/(mg/L) 148.0±86.4 279.2±180.9 0.001
Urinary citrate/(mg/24 h) 355.7±219.6 506.3±315.4 0.006
Urinary calcium/(mmol/L) 2.0±1.3 1.4±1.1 0.037
Urinary uric acid/(mmol/24 h) 1 793.4±863.4 1 235.0±765.0 0.001
Urinary P/(mmol/L) 14.8±6.7 10.4±6.9 0.003
Urinary Mg/(mmol/L) 1.9±0.8 1.6±1.1 0.202
Urinary creatine/(mmol/L) 8.6±3.0 6.4±3.9 0.002

表2

双能CT探测肾尿酸盐结石阳性和无肾结石组痛风患者的临床特征比较"

Items Positive uric acid kidney stone by DECT (n=34) Negative kidney stone by DECT (n=30) P
Age/years 44.9±7.4 42.4±10.7 0.475
Disease duration/months 108.3±72.2 49.1±28.4 0.001
Gout flare frequency/years 4 (1, 10) 1 (1, 2) 0.05
BMI/(kg/m2) 27.5±3.6 27.6±3.2 0.933
Serum uric acid/(μmol/L) 517.2±108.1 466.2±134.5 0.001
Serum creatinine/(μmol/L) 93.2±14.7 87.9±17.4 0.132
eGFR/(mL/min) 87.0±14.4 93.8±17.0 0.05
hsCRP/(mg/L) 13.4±2.8 10.1±2.5 0.891
Glucose/(mmol/L) 3.4±2.1 2.2±1.7 0.123
TG/(mmol/L) 1.9±0.8 2.6±2.4 0.089
TCHO/(mmol/L) 4.8±0.6 4.4±1.5 0.204
LDL-C/(mmol/L) 2.7±0.6 2.5±0.9 0.535
Urinary oxalic acid/(mg/L) 15.4±7.2 10.9±7.0 0.003
Urinary oxalic acid/(mg/24 h) 28.5±18.8 23.6±16.9 0.02
Urinary citrate/(mg/L) 183.3±126.2 314.9±193.3 0.001
Urinary citrate/(mg/24 h) 391.7±261.2 556.0±316.3 0.007
Urinary calcium/(mmol/L) 1.9±1.4 1.7±1.3 0.502
Urinary uric acid/(mmol/24 h) 1 684.2±812.1 1 518.1±893.4 0.371
Urinary P/(mmol/L) 13.6±6.2 12.8±7.5 0.583
Urinary Mg/(mmol/L) 1.5±0.5 1.9±1.1 0.083
Urinary creatine/(mmol/L) 8.6±3.1 7.3±3.7 0.077

图1

24 h尿草酸、枸橼酸对痛风患者肾尿酸盐结石诊断价值的受试者工作特征曲线"

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