Epidemic Investigation And Risk Factors Analysis Of Urolithiasis In Hospital

Background:Despite significant progress in the surgical treatment of urolithiasis in recent decades,the incidence of urolithiasis seems to be increasing year by year,causing a heavy economic burden on individuals and society,and has become a serious public health challenge.In recent years,many studies on the relationship between metabolic disorders/systemic diseases and urolithiasis have yielded indicative results,providing new methods for the treatment and prevention of urolithiasis.The academic circle hopes to use metabolic evaluation to reveal the causes of stone formation and adopt targeted,personalized prevention and treatment measures.Objective:(1)To investigate the proportion of urolithiasis in hospitalized patients and find clues to the correlation between stones and systemic diseases,so as to improve our understanding of urolithiasis;(2)Review the experience of metabolic evaluation of urinary stones in Peking Union Medical College Hospital,and summarize the standardized pattern of metabolic evaluation.On this basis,the correlation between urolithiasis and metabolic diseases,the feasibility of standardized pattern of metabolic evaluation were described and evaluated;(3)Based on the metabolic evaluation database,the metabolic risk factors of hypocitraturia in patients with renal stones were analyzed retrospectively.Through the study of the above three aspects,the relationship between urolithiasis and systemic diseases,especially metabolic diseases,is discussed.Methods:(1)All cases discharged from Peking Union Medical College Hospital from January 1,2017 to December 31,2017 were reviewed,including the ICD standard diagnosis,basic demographic characteristics and inpatient departments.In the study,we grouped the data according to the type of ward charge(ordinary or special ward)and whether or not the surgical department.Then analyze the whole hospital and each department seperately;(2)A descriptive evaluation method was used to review and analyze 534 metabolic evaluation cases of the Department of Urology of Peking Union Medical College Hospital from May 2016 to January 2021.The distribution differences of stone patients in gender,stone history,stone shape,stone composition,renal function,systemic metabolism and 24-hour urine metabolism were observed;(3)We reviewed 92 patients with kidney stones with complete clinical data included in the metabolic assessment database of the Department of Urology of Peking Union Medical College Hospital from May 2016 to January 2021.With hypocitraturia as the dependent variable,gender,age and metabolic abnormalities as independent variables,we conducted binary logistic regression analysis,to evaluate the metabolic risk factors of hypocitraturia.Results:(1)The proportion of urinary stones in discharged patients from the hospital from January 1 to December 31,2017 was 1.78%(1240/69518).Among them,the top ten departments with the highest proportion were departments of Urology,Endocrinology,General Internal Medicine,Infection,Nephrology,Traditional Chinese Medicine,Immunology,Gastroenterology,Emergency Department and Respiratory.Secondly,among discharged patients,the proportion of urolithiasis cases in non-surgical departments(2.75%,510/18573)was significantly higher than that in surgical departments(1.47%,659/44693).In addition,we found that the proportion of urolithiasis in patients in general wards(1.85%,1169/63299)was higher than that in VIP wards(1.14%,71/6252);(2)Among the metabolic evaluation cases completed from May 2016 to January 2021,there were more males than females in terms of gender differences;In terms of medical history,the average course of stone disease was about 10 years,and the first symptom is mainly renal colic;Calcium oxalate was the most common component of stone;In the distribution of calculi,renal stone were more than ureteral stone;In terms of systemic metabolism,hyperlipidemia was most common in patients of urolithiasis;In the aspect of 24h urine metabolism,the low concentration of urinary citrate was the most significant;(3)Among patients with renal stones,hypertension was risk factor for hypocitraturia(OR=4.48,95%CI:1.58～12.70).Other factors had not been found to be clearly related to hypocitraturia.Conclusion:Urolithiasis was closely related to systemic diseases,especially metabolic diseases.In the process of diagnosis and treatment of stones,doctors of internal medicine should pay attention to the correlation between stones and internal diseases,and actively participate in the diagnosis and treatment of urolithiasis.In the whole process of diagnosis and treatment of urolithiasis,it was an important method to use metabolic evaluation to find out the metabolic factors that may lead to stones.At present,the standardized pattern of metabolic evaluation could comprehensively evaluate the incidence of urolithiasis and systemic metabolic diseases in patients,which has excellent clinical practicability.Using the metabolic evaluation method,this study found that hypertension was a risk factor for hypocitraturia in patients with kidney stones.