摘要目的 评价红外光谱自动分析系统检测尿路结石成分的临床应用价值.方法 尿路结石标本1450例.男1032例,女418例.年龄6个月～88岁.男性平均年龄(41.7±15.3)岁,女性(42.0±15.6)岁.肾结石875例(60.34%),输尿管结石504例(34.76%),膀胱结石71例(4.90%).均采用LIIR型结石红外光谱自动分析系统分析.解析结果均行红外光谱人工解析验证,必要时辅以偏光显微镜、X线衍射或化学方法进行验证. 结果在结石总体构成比上,一水草酸钙结石714例(49.24%),碳酸磷灰石结石444例(30.62%),无水尿酸结石93例(6.41%),二水草酸钙结石92例(6.34%),六水磷酸铵镁结石28例(1.93%),胱氨酸结石23例(1.59%),尿酸铵结石20例(1.38%),二水尿酸结石16例(1.10%),二水磷酸氢钙结石12例(0.83%),一水尿酸钠结石2例(0.14%),碳酸钙结石1例(0.07%),其他5例(0.34%).结石的组合成分上,混合性结石1053例(72.62%),单一成分结石仅397例(27.38%).混合性结石主要为含钙类结石.其中15例婴幼儿结石为食用三聚氰胺污染奶粉所致,成分为二水尿酸与尿酸铵的混合结石.验证结果表明,结石主要成分误检6例(0.41%),将无水尿酸误检为尿酸铵或碳酸磷灰石;漏检9例(0.62%),其中漏检六水磷酸铵镁或碳酸磷灰石7例,性质不明2例.在2种和3种成分的混合性结石中,含量相对低的成分各漏检6例和10例,均为六水磷酸铵镁或碳酸磷灰石. 结论结石红外光谱自动分析系统分析尿路结石成分具有准确、自动、快捷等优点,适合临床常规使用.

abstractsObjective To determine the value of applying LIIR Automatic Analysis System of Infrared Spectroscopy in analyzing urinary stone composition. Methods 1450 samples of urinary stones were collected from 1032 male and 418 female patients. The age of patients ranged from 6 months to 88 years. The mean ages were 41.7±15.3 and 42.0±15.6 years for male and female patients, respectively. Of 1450 stones, 875 cases were located in kidney (60.34%), 504 cases in ureter (34.76%) and 71 cases in bladder (4.90%). All stones were analyzed by LIIR Automatic Analysis System of Infrared Spectroscopy (Tianjin). Analysis results were reevaluated by the artificial analysis of spectrogram, if necessary, with polarization microscope, chemical analysis, and X-ray diffraction.Results Calcium oxalate monohydrate stones were found in 714 cases (49. 24%), carbonate apatite stones in 444 cases (30.62%), anhydrous uric acid stones in 93 cases (6.41%), calcium oxalate dihydrate stones in 92 cases (6. 34 % ), ammonium magnesium phosphate hexahydrate stones in 28 cases (1.93%), cystine stones in 23 cases (1.59%), ammonium urate stones in 20 cases (1.38%), uric acid dihydrate stones in 16 cases (1.10%), brushite stones in 12 cases (0.83%), sodium urate monohydrate stones in 2 cases (0. 14%), calcium carbonate stones in 1 cases (0. 07%), and other stone types in 5 cases (0. 34%). Most urinary stones were composed of 2 or more compositions, and pure stones were only observed in 397 cases (27.38%). Most of the mixed stones contained calcium and non-calcium mixed stone was rarely observed. In addition, 15 stones were found in infants who had consumed melamine-contaminated milk powder. These stones were composed of uric acid dihydrate and ammonium urate. The results of reevaluation by artificial analysis showed the following: among pure and mixed stones, false detection occurred in 6 cases (0.41%), of which the composition was ammonium urate or carbonate apatite determined by automatic system but the true composition was anhydrous uric acid. False negative detection occurred in 9 cases (0.62%), of which the composition was ammonium magnesium phosphate hexahydrate or carbonate apatite in 7 cases, but in other 2 cases the composition could not be determined by artificial analysis. The false negative detection of components with relatively low content occurred in 6 cases and 10 cases in stones with 2 components and 3 components, respectively. The undetected composition in these cases was ammonium magnesium phosphate hexahydrate or carbonate apatite. Conclusion Automatic Analysis System of Infrared Spectroscopy has many advantages in accuracy, automation and is quick in analyzing the composition of urinary stones, and is worthy of promotion in clinical use.