肾结石是全球的泌尿系统常见病、 多发病, 且复发率高居不下。 一般认为, 尿中结石晶体的盐类呈超饱和状态, 以及尿中抑制晶体形成物质不足是肾结石产生的主要因素。 肾结石病因较复杂, 目前提出了多种有关肾结石病因的学说, 主要是从人体种族遗传、 疾病、 代谢和饮食习惯等方面研究结石病因, 来推测其导致不同的种类的产生, 再针对性制定治疗方案, 但临床上肾结石内科治疗效果仍欠佳。 积极探索肾结石形成和生长机制, 无疑能对科学治疗肾结石有积极的意义。 直观观察到结石的内部结构, 并根据这些结构特征推测出结石的形成和成长轨迹, 是研究肾结石形成和生长机制的重要一环。 传统的研究手段难以无损获得结石的内部结构, 目前未见肾结石微观结构相关报道。 高分辨率显微CT特别是同步辐射X射线显微CT的出现, 无疑能为这一研究提供先进的检测手段。 上海同步辐射光源作为第三代优质同步辐射光源, 具有高光子通量、 高准直性、 高极化性、 高相干性及宽频谱范围等特点, 其配合高分辨的X射线探测器可实现精确、 灵敏的组织结构信息的快速、 无损检测, 在保持标本完整性的前提下, 清晰再现样品内部的三维显微结构, 从而克服了传统的二维切片技术存在破坏组织结构的完整性、 无法准确获得组织结构的三维空间信息和基质成份等局限性。 利用上海同步辐射光源X射线显微CT技术, 对32例肾结石患者的结石微观结构进行了解析。 实验结果表明肾结石内部结构差异明显, 可归纳为6种类型: Ⅰ两相密实型; Ⅱ结晶型; Ⅲ连续多层沉积型; Ⅳ非连续多层沉积型; Ⅴ镶嵌式多孔型; Ⅵ复合型。 研究结果有助于进一步深入揭示肾结石生长机制, 也为肾结石更为精准治疗提供了新的科学视角和依据。

Kidney stones are a common and frequently-occurring disease of the urinary system worldwide, and their recurrence rate is still high. It is generally believed that the supersaturation of salts in urine and the lack of substances to inhibit the formation of crystals in the urine are the main causes of kidney stones. The etiology of kidney stones is complex. At present, a variety of theories about the etiology of kidney stones have been put forward, mainly from the aspects of heredity, disease, metabolism and eating habits, to study the etiology of kidney stones to infer the causes of different kinds of stones, and then make targeted treatment plans. However, the clinical effect of internal medicine treatment of kidney stones is still limited. Actively exploring the growth mechanism of stones will undoubtedly be of positive significance to the scientific treatment of kidney stones. It is important to observe the internal structure of the stones and infer the formation and growth track of the stones according to these structural characteristics. It is difficult to obtain the internal structure of kidney stones by traditional research methods, so there are few reports on the microstructure of kidney stones. The appearance of high-resolution microCT, especially synchrotron X-ray microCT, can undoubtedly provide advanced detection means for this research. As the third generation of high-quality synchrotron radiation source, Shanghai synchrotron radiation facility (SSRF) has the advantages of high photon flux, collimation, polarization, coherence and wide spectrum. The synchrotron radiation X-ray detector can realize the fast and non-destructive detection of accurate and sensitive tissue structure information. It can reproduce the three-dimensional microstructure inside the sample on the premise of maintaining the integrity of the sample. Thus, this new detection method overcomes the limitations of traditional two-dimensional slicing technology, such as destroying the integrity of tissue structure and being, unable to accurately obtain the three-dimensional spatial information as well as matrix composition of tissue structure. In this study, the X-ray microCT technique at SSRF was used to analyze the microstructure of kidney stones from 32 patients. The research results showed that there were obvious differences in the internal structure of kidney stones, which could be divided into six types: Ⅰ the two-phase compact type; Ⅱ the crystalline type; Ⅲ the continuous multilayer deposition type; Ⅳ the discontinuous multilayer deposition type; Ⅴ the mosaic porous type; Ⅵ the composite type. The results of this study would contribute to reveal the growth mechanism of kidney stones further, and provide a new scientific perspective and basis for more accurate treatment of kidney stones.