Metabolic Evaluation Of Randall's Plaque Patient And Analysing Risk Factor Of Lithiasis

Background and Objective:Urolithiasis is a common and frequent disease in urology,ranking first among urological inpatients in China.Although the treatments and surgical methods of calculi have made a great progress with the development of science and technology,there are still many unknown mechanisms and reasons of urolithiasis,which also lead to high incidence and high recurrence rate of urolithiasis.Metabolic abnormality is one of the important factors in the formation of urinary calculi.In recent years,many studies have pointed out that the contents of calcium,phosphorus,magnesium,citrate,uric acid and oxalic acid in urine are closely related to the formation of stones,and the patient's 24 h urine can be used to assess the risk of stone formation and recurrence.Metabolic assessment is a method in which stone disease is considered as a chronic metabolic disease in recent years,and then metabolic studies are carried out.Metabolic assessment consists of a series of tests including stone component analysis,24 h urine component analysis,blood electrolytes,and parathyroid hormone tests.Metabolic assessment can not only identify potential risk factors that affect the occurrence of stones,but it also provides a basis for clinical treatment.Importantly,metabolic assessment can provide guiding significance for preventing stone recurrence.Randall plaque,also known as Randall's plaque,is a calcified plaque which presents under the epithelial tissue of the renal papilla.It is composed of collagen,mucopolysaccharide,calcium ion and phosphate,and it is considered to be the origin of stone disease.Stove.Randall discovered that it was a perfect attachment point for calcium oxalate stones by anatomizing more than 1,000 cadaveric kidneys,and induced the formation of calcium oxalate stones.The stone formation mechanism of Randall plaque is thought to be related to calcification nanoparticles,reactive oxygen species and oxidative stress reaction,but there is no specific principle,and there is no 24-h urine metabolism evaluation study for randall plaque patients.Therefore,this study uses randall calculus patients as the research object to study the metabolic characteristics of 24 h urine in patients with randall calculus and explores the related mechanisms of stone formation.Methods:50 patients with renal calculi or percutaneous nephrolithotomy treated with ureteroscopy or percutaneous nephrolithotomy at the Second Affiliated Hospital of Zhengzhou University from October 2017 to October 2018 were selected and divided into the following two groups according to the intraoperative situation: Randall plaque group can find typical renal papillary plaque by ureteroscopy or percutaneous nephrolithotomy,and no Randall plaque group is calculus without renal papillary plaque.The postoperative stone composition is calcium oxalate monohydrate or dihydrate.Calcium oxalate or mixed components are mainly composed of calcium oxalate.At the same time,30 healthy people with healthy no stone disease wereselected as the control group.Randall plaque group was enrolled in 30 patients,age was(47.1±18.35)years old;no Randall plaque group was enrolled in group 20,age was(49.95±13.25)years old;normal group was enrolled in group 30,age was(42.3±11.41)Years old.The general clinical data of the three groups of personnel were collected,and clinical data such as the location and size of Randall plaques and those without Randall plaques were collected.Collect 24 hours of urine from three groups of people.After emptying the bladder before 8:00 on the first day(without leaving morning urine),start collecting urine into a sealed plastic bucket and collect it for 24 hours until 8 am the next morning.1 ml of concentrated hydrochloric acid was added to each 100 ml of urine for preservation,and the urine was sent for inspection within24 hours after collection.The differences between 24 hours urine metabolism between the three groups were compared.The statistical data were analyzed by SPSS17.0 statistical software.The quantitative data were used to describe the mean and standard deviation.The comparison between groups was performed by independent sample t test.The test was statistically significant at P < 0.05.Results:There were 22 males and 8 females in Randall's plaque group,and No-Randall's plaque group includes 15 males and 5 females,control group including 17 males and13 females.There was no significant difference in sex,age and BMI between Randall's plaque group,No-Randall's plaque group and control group(P > 0.05);A),and there was no significant difference in stone size and position between Randall's plaque group,No-Randall's plaque group and control group(P > 0.05).The content of sodium,calcium,oxalate and phosphoric acid in Randall's plaque group are higher than these in the control group,and the content of sodium,calcium and phosphate in Randall's plaque group are higher than these in No-Randall's plaque group.The citrate in Randall's plaque group is lower than it in No-Randall's plaque group and controlgroup.In No-Randall's plaque group,oxalate is higher than it in control group,and citrate is lower than it in control group.Conclusions:1.High sodium,calcium,oxalic acid,phosphoric acid and low niacin in 24 h urine are closely related to Randall plaque formation and stone formation.2.In the formation progress of urinary calcium oxalate stones,low citric acid and high oxalic acid are associated with the formation of stones.3.It can be seen that metabolic abnormalities play a vital role in the urinary stone formotion.The metabolic evaluation can further understand the stone formation mechanism of Randall plaque patients,and the exploration of Randall plaque formation mechanism may play an important role in preventing calculi occurrence and recurrence.