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目的:探讨一种三聚氰胺尿路结石的发生机制模型。方法:收集三聚氰胺尿路结石24枚(试验组),随机选择19枚成人尿路结石作为对照组,测定试验组患儿肾功能和血尿酸、肌酸水平。使用高效液相色谱法测定结石样本肌酐、肌酸和尿酸含量,使用高分辨透射电镜研究上述结石提取物、人工制备的三聚氰胺-三聚氰酸聚合物、色谱级尿酸、肌酸和肌酐标准品结构。结果:试验组患儿血生化指标均正常,且无个体间显著差异。试验组结石肌酸(6.17±8.09μg/g vs 0.19±0.16μg/g,P=0.000)和肌酐(20.49±21.91μg/g vs 2.09±1.06μg/g,P=0.008)含量较对照组显著增高。但患儿血生化指标与上述结石指标之间无明显相关(P>0.05)。电镜研究显示:试验组结石核心区域提取物中发现的网状结构与人工制备的三聚氰胺-三聚氰酸聚合物结构极其相似,而且肌酸、肌酐和尿酸分子均小于上述网状结构网格尺寸。结论:本研究首次证实三聚氰胺结石中存在独特的类三聚氰胺-三聚氰酸聚合物的网状结构,其可能参与结石发生中的成核作用。
Objective: To investigate a mechanism of melamine urinary tract stones. Methods: Twenty-four melamine urinary stones (experimental group) were collected and 19 adult urinary calculi were randomly selected as the control group. The renal function, serum uric acid and creatine level in the experimental group were measured. Creatinine, creatine and uric acid were determined by high performance liquid chromatography (HPLC). High resolution transmission electron microscopy was used to study the above stone extract, artificially prepared melamine-cyanuric acid polymer, chromatographic grade uric acid, creatine and creatinine standard structure. Results: The blood biochemical indexes in the experimental group were all normal, and there was no significant difference between the two groups. The levels of creatine (6.17 ± 8.09μg / g vs 0.19 ± 0.16μg / g, P = 0.000) and creatinine (20.49 ± 21.91μg / g vs 2.09 ± 1.06μg / g, P = 0.008) in the experimental group were significantly higher than those in the control group Increase. However, children with biochemical markers of blood stones and no significant correlation (P> 0.05). Electron microscopy studies showed that the network structure found in the extract of calculi in the test area was very similar to that of the melamine-cyanuric polymer prepared manually, and the molecular weights of creatine, creatinine and uric acid were all less than those of the above network structure . CONCLUSIONS: This study for the first time confirms the presence of a unique network of melamine-cyanuric acid polymers in melamine stones that may be involved in the nucleation of stones.