服用柠檬酸钾前后草酸钙结石患者的尿微晶和尿液性质变化

采用透射电子显微镜(TEM)、扫描电子显微镜(SEM)、X射线衍射(XRD)、傅立叶变换红外光谱(FTIR)和ζ电位分析仪研究了草酸钙(CaOxa)结石患者在服用柠檬酸钾(K3cit)前后尿液中微晶的性质变化,这些性质包括:尿微晶的形貌、尺寸、聚集状态、质量、种类和ζ电位,并研究了服药前后尿液的稳定性差异和pH值变化。服用K3cit前,结石患者的尿微晶棱角尖锐,聚集明显,尺寸从几十纳米到几百微米不等,主要为一水草酸钙(COM)、尿酸等;而服用K3cit一周后,部分尿微晶的形状变得圆钝,聚集现象明显减少,平均粒径减小,部分尿微晶的表面出现凹陷,二水草酸钙(COD)和尿酸盐的百分含量增加,尿微晶的数量和种类减少,尿液pH值上升,ζ电位绝对值增加,自相关时间增加。从患者服用K3cit后引起尿pH值增加、尿液中排泄的柠檬酸和Tamm-Horsfall蛋白浓度增加、柠檬酸与Ca2+离子配位等角度,讨论了K3cit抑制CaOxa结石形成的机制。

Property Change of Urine Crystallites and Urine Compositions of Calcium Oxalate Stone Patients before and after Taking Potassium Citrate

The property change of urine crystallites of calcium oxalate stone patients before and after taking potassium citrate(K3cit) were comparatively studied using transmission electron microscopy(TEM),scanning electron microscope(SEM),X-ray diffraction(XRD),Fourier transform infrared(FTIR) spectroscopy,and ζ potential analyzer.The properties including the morphology,particle size,state of aggregation,quantity,composition and ζ potential of urinary crystallites.The change of stability and pH value of urines were also investigated.Before taking K3cit,the edges and corners of urine crystallites were sharp with significant aggregation.Their particle size was ranging from tens of nanometers to several hundreds of micrometers.The main composition was calcium oxalate monohydrate(COM),uric acid and so on.While after taking K3cit for one week,some of urine crystallites became blunt,the aggregated crystallites and the average size were obviously reduced,some hollows appeared on the surface of the crystallites,the percent of calcium oxalate dihydrate(COD) and urate increased,the number of compositions and quantity of urine crystallites were reduced,and the urinary pH and the absolute value of ζ potential increased.The mechanism of how K3cit inhibiting the formation of calcium oxalate stone was discussed from the point of the rise of urinary pH,the increase of excretion of citric acid and TH protein,and the coordination between citric acid and Ca2+ ions etc.