Statins类药物可能可以预防肾结石


  【24drs.com】根据一篇回溯研究,高血脂症患者中,statins类药物可能可以降低肾结石形成风险。但是,某些专家认为,这篇结果还不足以用来促成预防性使用降血脂药物。
  
  芝加哥大学医学中心泌尿科医师Andrew Cohen在美国泌尿科协会2016年会中表示,这项研究是及时的。他在记者会中向记者们表示,血中脂质程度、服用statin类药物、慢性肾病、肾结石之间的关联,在目前广被研究与辩论。
  
  之前认为脂质上升与肾结石有关,一篇有57,000名新诊断有高血脂症患者的研究首度指出,使用statin类药物者发生结石的风险低于未使用者(Clin Nephrol. 2013;79:351-355)。
  
  所以,Cohen医师与北岸大学医疗系统(共有超过100个地点)的研究伙伴决定进行一篇大型研究以确认这些保护效果。
  
  研究团队使用电子病历系统回顾在2009-2011年间诊断有高血脂症的101,250名患者的资料,这些患者在诊断时都未曾用过statin类药物。追踪这些患者直到2015年,研究的初级终点是发生肾结石。
  
  约半数(48%)研究对象后来有使用statin类药物,约半数(52%)未使用。
  
  单一变项分析中,statin类药物使用者发生新结石的机率显著低于未使用者(3.8% vs 4.7%;P< .01)。
  
  校正年龄、种族、身体质量指数(BMI)、性别、共病症后,多变项分析确认了statin类药物对于新发生结石的保护效果(胜算比[OR]为0.57;P< .01)。
  
  某些研究对象在发生高血脂症之前曾有肾结石病史。值得注意的是,多变项分析指出,statin类药物在这些有结石病史患者的保护效果,大于那些有结石病史但没有statin类药物处方者(OR, 0.53;P< .01)。Cohen医师报告指出,这个风险实质上减少了一半。
  
  多变项分析是必要的,因为,其它差异化之中,没有被处方statin类药物的患者比未使用者更年轻(51.9 vs 60.7岁;P< .01)且较不肥胖(28.1 vs 29.2kg/m2;P< .01)。
  
  值得注意的是,在追踪期间,statin类药物使用者的低密度脂蛋白值和总胆固醇值显著低于未使用者,这代表有遵医嘱使用药物。
  
  Cohen医师强调这个研究结果,因为之前有关此一主题的研究缺乏检验数字分析,他表示,这些检验资料对我们的研究结果增添了高度可信度。
  
  他指出,这篇研究也确认了发生结石的其它风险,例如:过重、黑人、年长、有骨质疏松、有thiazide处方。
  
  他报告指出,当研究者探讨血中脂质和未来肾结石风险的关联时,只有三酸甘油脂上升被证明是未使用statin类药物者发生结石的风险因素,低密度脂蛋白值或总胆固醇值上升和肾结石无关。
  
  这篇研究也有一些限制。Cohen医师解释,当患者们知道他们有高血脂症时,他们可能会改变他们的饮食或生活型态,此外,高胆固醇值往往是略高而不是非常高,因此,这些结果可能无法应用到数值非常高的患者。
  
  但是,匹兹堡大学泌尿科医师、主持记者会的Timothy Avench医师表示,这篇研究的结论 — statin类药物对预防高血脂症成人形成肾结石有保护效果 — 在目前依旧是个学术问题。
  
  他表示,这些结果即使加上2013年研究的结果,还不足以促成预防性使用statin类药物,在实务上要实现这一点,将需要很大的力量。
  
  资料来源:http://www.24drs.com/
  
  Native link:Statins May Protect Against Kidney Stones

Statins May Protect Against Kidney Stones

By Nick Mulcahy
Medscape Medical News

SAN DIEGO — In patients with hyperlipidemia, statins might reduce the risk for kidney stone formation, according to a retrospective study. But, for some experts, the results are not enough to prompt the prophylactic use of the lipid-lowering drugs.

The study is timely, lead author Andrew Cohen, MD, a urologist from the University of Chicago Medical Center, said here at the American Urological Association 2016 Annual Meeting.

"The relation between levels of lipids in the blood, the intake of statins, chronic kidney disease, and kidney stones is being researched and debated currently," he told reporters during a press conference.

Elevated lipid levels have previously been associated with kidney stones. A study of 57,000 patients newly diagnosed with hyperlipidemia, showed, for the first time, that the risk for stone development was lower in statin users than nonusers (Clin Nephrol. 2013;79:351-355).

So Dr Cohen and his colleagues at the North Shore University Health System (which has more than 100 locations) decided to conduct a larger study to confirm these protective effects.

The team used the electronic medical records system to review data on more than 101,250 patients diagnosed with hyperlipidemia from 2009 to 2011 who were statin-naive at diagnosis. The patients were followed until 2015. The primary end point of the study was the development of kidney stones.

About half (48%) the population subsequently received a statin and about half (52%) did not.

On univariate analysis, the statin users were significantly less likely to develop new stones than the nonusers (3.8% vs 4.7%; P< .01).

Multivariate analysis, adjusted for age, race, body mass index (BMI), sex, and comorbidities, confirmed the protective effect of statins on new stones (odds ratio [OR], 0.57; P< .01).

Some of the study participants had a history of kidney stones before they developed hyperlipidemia. Notably, multivariate analysis indicated that the protective effect of statins was even greater in these patients than in patients with a history of stones but no statin prescription (OR, 0.53; P< .01). The risk was "essentially cut in half," Dr Cohen reported.

The multivariate analysis was necessary because the patients who were not prescribed statins were, among other differentiators, significantly younger than nonusers (51.9 vs 60.7 years; P< .01) and less obese (28.1 vs 29.2kg/mm2; P< .01).

Notably, on follow-up, average levels of low-density-lipoprotein cholesterol and total cholesterol were significantly lower in statin users than in nonusers, suggesting compliance with medications.

Dr Cohen stressed this finding because the earlier research on this subject lacked this analysis of lab values. This supplementary lab data added a "high degree of credibility" to our study findings, he said.

The study also confirmed other risk factors for stone development, such as being overweight, being black, being older, having osteoporosis, and having a thiazide prescription, he noted.

When the researchers looked at the relation between lipids in the blood and the risk for future kidney stones, only elevated triglyceride levels were found to be a risk factor for the development of a stone in nonusers of statins, he reported. "There was no association between elevated LDL or total cholesterol and nephrolithiasis."

The study had some limitations. When patients learned they had hyperlipidemia, they might have changed their diet or lifestyle. Plus, high cholesterol levels were often "borderline," not extremely high, Dr Cohen explained. Therefore, these results might not apply to patients with very high levels.

But the study's conclusion — that statins have a protective effect against the formation of kidney stones in adults with hyperlipidemia — will have to remain an academic matter for now, said Timothy Avench, MD, a urologist at the University of Pittsburgh, who moderated the press conference.

The results, even when combined with those from the 2013 study, are not enough to prompt a prophylactic use of statins. "It will take a lot of force to make this show up in practice," he said.

Dr Cohen has disclosed no relevant financial relationships. Dr Avench reports a financial relationship with Bard Medical.

American Urological Association (AUA) 2016 Annual Meeting: AbstractPD31-10. Presented May8, 2016.

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick

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