美国的肾结石发生率持续增加


  【24drs.com】在线发表于1月14日美国肾脏学会临床期刊的一篇研究显示,越来越多美国人发生肾结石,且风险增加的人口结构正在产生变化。
  
  针对南卡罗来纳州152,925名孩童及成年肾结石患者的分析发现,1997-2012年间,肾结石的年发病率增加了16%,青少年、女性、黑人所观察到的增幅最大。
  
  宾州费城儿童医院小儿泌尿科Gregory E. Tasian医师等人报告指出,虽然2012年时的女孩与男孩发生风险分别只有0.9%和 0.6%,但在这段研究期间内,孩童的肾结石发生累积风险几乎倍增,女孩增加87%,男孩增加90%。
  
  Tasian医师在记者会中表示,儿童出现肾结石,尤其令人担忧,因为如何治疗这类儿童的证据相当有限。
  
  研究作者们解释,儿童肾结石的评估和治疗措施方面,还有一些变化,包括对于疑似肾结石的孩童,难以遵守减少放射线曝露之指引,而使用手术介入方面则端赖地区医疗资源以及临床适应症之易用性。
  
  研究者假设,青少年的肾结石风险增加可能是因为钠的摄取量增加、钙摄取减少或脱水。
  
  在这段研究期间内,根据性别考量时,男性的肾结石终身风险依旧稳定,约为23%,但是妇女在1997-2012年间增加45%,从10.5%增加到15.2%。作者们指出,校正年龄与种族之后,女性每5年的发生率估计增加15%。
  
  作者们报告指出,在15-19岁者观察到的发生率增加最多,校正年龄与种族之后,每5年的发生率增加26%。
  
  作者们观察发现,随著时间,肾结石的发生率变化显著因种族而异,黑人每5年的发生率估计增加15%,白人每5年的发生率估计增加3%。
  
  作者们写道,研究结果指出一个反向的历史趋势,需要后续研究,了解年龄、性别与种族差异等可修饰的发生率风险因素,将有助于次级预防策略,特别是那些以前肾结石率低,现在日益增加的族群。
  
  资料来源:http://www.24drs.com/
  
  Native link:Kidney Stones on the Rise in the United States

Kidney Stones on the Rise in the United States

By Diana Phillips
Medscape Medical News

More Americans than ever are developing kidney stones, and the demographics of those at increased risk are changing, a study published online January 14 in the Clinical Journal of the American Society of Nephrology has shown.

In an analysis of data from 152,925 child and adult patients with kidney stones in South Carolina, the annual incidence of nephrolithiasis increased 16% between 1997 and 2012, with the greatest rates of increase observed among adolescents, females, and blacks.

The cumulative risk of developing kidney stones during childhood nearly doubled, at 87% among girls and 90% for boys, during the course of the study, "although the risk in 2012 was modest at 0.9% and 0.6% in girls and boys, respectively," Gregory E. Tasian, MD, from the Division of Pediatric Urology at the Children's Hospital of Philadelphia in Pennsylvania, and colleagues report.

"The emergence of kidney stones in children is particularly worrisome, because there is limited evidence on how to best treat children for this condition," said Dr Tasian in a press release.

As a result, "there is unwanted variability in evaluation and treatment practices for children with nephrolithiasis, including poor adherence to guidelines aimed at reducing radiation exposure among children with suspected nephrolithiasis and use of surgical interventions that are dependent more on local availability and ease of use than clinical indications," the study authors explain.

The researchers hypothesize that the increased risk for kidney stones among youth may be attributable to increased sodium intake, decreased calcium intake, or dehydration.

When considered by sex, the lifetime risk for kidney stones in men remained stable, at approximately 23%, during the study period but increased 45% between 1997 and 2012 among women, going from 10.5% to 15.2%. After adjusting for age and race, the incidence among females increased an estimated 15% per 5 years, the authors note.

The highest rate of increased incidence was observed among 15- to 19-year-olds, at 26% per 5 years after adjustment for age and sex, the authors report.

The changes in kidney stone incidence over time were significantly modified by race, with an estimated 15% increase per 5 years observed among blacks compared with an estimated 3% per 5 years among whites, the authors observe.

The study findings point to a reversal of historical trends that warrants further research, the authors write. "Understanding modifiable risk factors that account for the age, sex, and race differences in incidence rates will facilitate targeted secondary prevention strategies, particularly for those groups in which nephrolithiasis were once rare but are now increasing."

The study was supported by the Children's Hospital of Philadelphia and the National Institutes of Health. The authors have disclosed no relevant financial relationships.

Clin J Am Soc Nephrol. Published online January 14, 2016.

    
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