尿路结石形成机理的新进展（邓耀良）课件.pptVIP

2010/9/17 广西医科大学第一附属医院泌尿外科 尿路结石形成机理的新进展 广西医科大学第一附属医院 邓耀良 2010.9 广州 内容 奇异的核心 核心与肾结石 令人烦恼的纳米细菌 肾结石形成的途径 肾内钙沉着与Randall’s plaque 展望 含金属离子矿化核心的特性 1. 通常呈球形和分层状 2. 在主要的生物种类中都普遍存在 3. 通常具有溶酶体的功能 4. 直径在0.1 ～ 100纳米之间 5. 通常存在于细胞内外 6. 主要是不定型的CaP (as apatite) or CaCO3 7. 可以包含有 Mg, Se, Pb, Cd, Zn, U, Ba, Sr, Mn, Na, K, Si, S, Hg 8. 通常存在于消化、储存和排泄器官肾脏 9. 其结构和大小与饮食、年龄、种族和环境有关 含金属离子矿化核心的功能 1. 废物处理 2. 渗透调节 3. 过量离子的排泄 4. 钙的储存与调节 5. 磷的储存与调节 6. 碳酸盐的储存与调节 7. 骨架功能 (壳, 表皮等) 8. 有毒重金属的解毒作用 In the proceedings of the 2006 Indianapolis UrolithiasisSymposium Professor Fred Coe [98] asked a battery ofhighly pertinent research questions about Randall’s plaque,the stone–plaque junction, and the plugging of the innermedullary collecting ducts with apatite deposits: Does plaque cause erosion and apoptosis at the papillary epithelium? What is plaque matrix composed of? Do HAP crystals aVect H+ secretion by IMCD cells? Where is plaque made? Is plaque aVected by urine calcium, volume and pH? How is the epithelial barrier breached? How does plaque form? Do HAP crystals aVect NH4+ transporters in IMCD cells? Do urine ions crystallize on plaque? Can we study the mechanisms of HAP attachment? What leads to IMCD injury by biological apatite? What is the stone matrix at the attachment site? Will plaque particles form in cultured cell systems? Stone research in the 21st century 一、草酸钙结石的危险因素 低尿量 高钙尿症 高草酸尿症 低枸橼酸尿症 高尿酸尿症 高钠尿症 Finkielstein VA, Goldfarb DS. Strategies for preveting calcium oxalate stones.CMAJ,2005,174(10):1407-1409. Atan L,Andreoni C, Ortiz V, et al . High kidney stone risk in men working in steel industry at hot temperaturres. Urology, 2005,65(5):858-861 Ku JH, Jung TY, Lee JK Risk factors for urinary stone formation in men with spinal cord injury: a 17-year follow-up study.BJU Int. 2006 Apr;97(4):790-3. Straub M, Hautmann RE. Developments in stone prevention. Curr Opin Urol. 2005, 15(2):119-126 　　二、Randall’s Plaque：草酸钙肾结石形