感染結石の構築 とくに核部構築について

Abstract

1)腎結石40例のうち27例は核部も外層部と同じリン酸塩であったが, 13例は蓚酸カルシウムを核部成分としていた.膀胱結石にも核部成分の異なるものがみられた.2)核部が同一成分の感染結石では, 構築は外層部とほぼ同一で核内に多数の細菌がみられ, 細菌自体も核形成に重要な役割を演じていると考えられた.3)蓚酸カルシウムを核部成分とする感染結石では核部内に細菌は認められず, 核部外側の移行部に細菌が認められ, 蓚酸カルシウム結石に感染が加わり感染結石に変化したものと考えられた.4)同一成分の感染結石をprimary infection stoneとすれば, 成分の異なる感染結石はsecondary infection stoneと呼ぶべきもので, 再発予防にはそれに応じた原因を探しこれを除去すべきである

The composition and structure of nuclei of infection stones were investigated. Twenty seven out of 40 renal stones were found to contain struvite and/or carbonate apatite in the nuclei as well as peripheral layers, and 13 contained calcium oxalate. Some bladder stones also contained different substances in the nuclei. In some infection stones whose architecture was studied in thin section and with scanning electron microscopy, we found large numbers of bacteria in the nuclei composed of struvite and/or apatite. Though we could find no bacteria within the nuclear parts composed of oxalate, we found them in apatite layers outside the nuclei. Urea-splitting bacteria are suggested to participate both in the initial formation of struvite stones and in the diversion of oxalate stones into phosphate stones. Such bacteria may play important roles in stone formation, not only as promotors of crystallization of struvite and apatite but also as a component such as of an organic matrix.