肾结石与主动脉钙化高风险有关


  【24drs.com】一篇回溯研究认为,相较于没有发生肾结石的人,患有钙性肾结石的患者,发生腹主动脉钙化(AAC)的风险比较高,且脊椎骨质密度(BMD)降低。
  
  这篇研究在线发表于1月29日美国肾脏学会临床期刊。
  
  英国伦敦大学院医学院皇家自由医院院区的Linda Shavit医师等人发现,腹主动脉钙化盛行率在肾结石患者(38%)与没有结石的对照组患者(35%)相似;不过,有肾结石者(KSFs)中,68%有中到严重的腹主动脉钙化,无肾结石者对照组则只有26% (P < .001)。
  
  根据计算机断层(CT)分析骨质密度,曾患肾结石之患者测得数值为159 Hounsfield单位,也显著低于无肾结石者测得的194 Hounsfield单位(P <.001)。
  
  作者们观察发现,使用计算机断层扫描测量腹主动脉钙化,是考虑到它是心血管相关发病率或死亡的强力预测因子,我们的研究用来测量结石患者与健康对照组的血管钙化负担。
  
  多变项分析校正所有潜在的共变项,确认肾结石与血管钙化的严重类型具有独立关联。
  
  研究者进行一项回溯配对案例控制研究,纳入2011-2014年间、于英国伦敦皇家自由医院肾脏科门诊就医的肾结石患者进行研究。
  
  研究者从该医院的潜在活体肾脏捐赠者名单中,配对年龄和性别相仿的非结石者,研究对象共111人,57名患有肾结石、54名健康对照组,两组的平均年龄都是47岁。
  
  腹主动脉钙化与脊椎骨质密度都是使用计算机断层扫描测量,腹主动脉钙化严重度分数(以中位数[25th、75th]代表),肾结石组都显著高于对照组(0 [0、43]相较于0 [0, 10];P < .001)。
  
  多变项模式校正了年龄、性别、高血压、糖尿病、抽菸、估计肾丝球过滤速率等,肾结石者与无肾结石者的腹主动脉钙化分数差异是3.78单位(P < .001);同样地,在这个多变项模式中,两组计算机断层的骨质密度分析差异为-35.88 Hounsfield单位(P < .001)。
  
  腹主动脉钙化分数较高也与肾结石患者及无肾结石患者的骨质密度较低有强烈关联(P < .001)。
  
  研究者写道,我们的研究显示,钙性肾结石患者的主动脉钙化比率显著高于年龄性别相仿的无结石者,表示血管钙化是可以用来解释肾结石和[心血管疾病]之关联的潜在机转。
  
  波特兰缅因医学中心的Eric Taylor医师在编辑评论中指出,这篇研究对于医界了解钙性肾结石、骨质密度较低与心血管疾病之间的关联代表著一个重要的贡献。
  
  如同Taylor所指出的,腹主动脉钙化是相关研究指标,与冠状动脉钙化正相关,非致死性和致死性冠状动脉心脏疾病事件的一个既定预测因子。
  
  Taylor医师表示,相对的,这篇研究并未阐释机制,从而引发的问题多于答案。同时,执业肾脏科医师会有疑惑:研究的现状会如何影响钙结石患者目前的照护。
  
  目前还无法将有结石病史整合到骨质疏松症或心血管疾病风险的筛检指引,Taylor医师指出,不过,精明的医生们很清楚,最好的疗法往往不是最新或最复杂的。鼓励人们多吃水果、蔬菜与全谷类,减少红肉与精制肉类和汽水,永远都是好时机。
  
  资料来源:http://www.24drs.com/

Kidney Stones Linked to Higher Risk for Aortic Calcification

By Pam Harrison
Medscape Medical News

Patients who form calcium kidney stones are more likely to have higher abdominal aortic calcification (AAC) and lower vertebral bone mineral density (BMD) scores than those who do not develop kidney stones, a retrospective study suggests.

The study was published online January 29 in the Clinical Journal of the American Society of Nephrology.

Linda Shavit, MD, from the Royal Free Campus and Hospital, University College London Medical School, United Kingdom, and colleagues found that the prevalence of AAC was similar in patients who formed kidney stones (38%) compared with in non–stone forming control patients (35%).

However, 68%, of kidney stone formers (KSFs) had moderate to severe AAC scores compared with only 26% of non–stone forming controls (P < .001).

The average BMD, as assessed by computed tomography (CT), was also significantly lower, at 159 Hounsfield units in patients with a history of kidney stones compared with 194 Hounsfield units for those who did not (P < .001).

"[AAC] measured by CT scan is considered as a strong predictor of CV-related morbidity or death and was used in our study as a measure of [vascular calcification] burden in KSF and healthy control patients," the authors observe.

"[M]ultivariate analyses adjusted for all potential confounders confirmed that kidney stone disease is independently associated with advanced forms of [vascular calcification] compared with non-KSF."

Investigators carried out a retrospective matched case-control study that included KSFs attending the outpatient nephrology clinic of the Royal Free Hospital in London, United Kingdom, between 2011 and 2014.

The researchers drew age- and sex-matched non–stone formers from a list of potential living kidney donors from the same hospital. They investigated a total of 111 patients, 57 of whom were KSFs and 54 of whom were healthy controls. The mean age of both groups was 47 years.

AAC and vertebral BMD were assessed using CT imaging. AAC severity scores (presented as median [25th, 75th]) were significantly higher at in the KSF group compared with controls (0 [0, 43] vs 0 [0, 10]; P < .001).

The difference in AAC scores on multivariate models adjusted for age sex, high blood pressure, diabetes, smoking status, and estimated glomerular filtration rate was 3.78 units between KSF and non–stone formers (P < .001).

Similarly, the difference between the two groups on CT measures of BMD in the same multivariate model was ?35.88 Hounsfield units (P < .001).

A higher AAC score also strongly correlated with lower BMD in both KSFs and non–stone formers (P < .001).

"Our study demonstrates that patients with calcium kidney stones suffer from significantly higher degrees of aortic calcification than age- and sex-matched non-stone formers," the investigators write, "suggesting that [vascular calcification] may be an underlying mechanism explaining reported associations between nephrolithiasis and [cardiovascular disease]."

Important Contribution

In an accompanying editorial, Eric Taylor, MD, from the Maine Medical Center, Portland, notes that the study represents "an important contribution" to the medical community's understanding of the potential relationships among calcium nephrolithiasis, lower BMD, and cardiovascular disease.

As Dr Taylor points out, AAC is a relevant study metric, being positively correlated with coronary artery calcification, an established predictor of incident nonfatal and fatal coronary heart disease.

In contrast, the study was not designed to elucidate mechanisms, and thus raises more questions than answers, Dr Taylor suggests.

"In the meantime, practicing nephrologists are left to wonder how the current state of research may affect the care of the patient with recurrent calcium stone disease," he writes.

It is still too early to incorporate a history of stone formation into current screening guidelines for either osteoporosis or CVD risk factors. "However, the savvy clinician is well aware that often the best therapies are not the newest or most complicated," Dr Taylor notes. "Perhaps it is always the right time to encourage a healthy diet with more fruits, vegetables, and whole grains and less red and processed meats and soda."

One coauthor is currently on secondment as a Chief Scientist with AstraZeneca. The other authors and Dr Taylor have disclosed no relevant financial relationships.

Clin J Am Soc Nephrol. Published online January 29, 2015.

    
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