Kramer Holly J, Choi Hyon K, Atkinson Karen, Stampfer Meir, Curhan Gary C
Department of Preventive Medicine and Epidemiology, Division of Nephrology, Loyola University Medical Center, Maywood, Illinois, USA.
Kidney Int. 2003 Sep;64(3):1022-6. doi: 10.1046/j.1523-1755.2003.t01-2-00171.x.
Approximately 10 million adults in the United States have experienced the passage of a kidney stone, and up to 5 million have been diagnosed with gout by a physician. Previous reports have suggested that gout increases the risk for the development of kidney stones, but there are no prospective data. We used data from a cohort of 51,529 male health care professionals to examine the independent association between gout and kidney stone disease. In a cross-sectional analysis of gout and kidney stone disease reported on the 1986 baseline questionnaire, the prevalence of kidney stone disease was almost twofold higher in men with history of gout compared to those without (15% vs. 8%). After adjusting for age and body mass index (BMI), a history of gout remained significantly associated with kidney stone disease (OR 1.88; 95% CI 1.68 to 2.11). We then prospectively examined the risk of incident kidney stones in men with and without a confirmed diagnosis of gout after excluding men who reported a history of kidney stone disease or gout on the baseline questionnaire. A confirmed diagnosis of gout increased the multivariate relative risk of incident kidney stones (RR 2.12; 95% CI 1.22 to 3.68). In contrast, a history of kidney stone disease was not associated with increased risk of gout (RR 1.05; 95% CI 0.54 to 2.07). In conclusion, a history of gout independently increases the risk for incident kidney stones in men. Physicians should provide dietary counseling, such as increasing fluid intake and decreasing salt consumption, to subjects with gout in addition to other risk factors, such as family history of kidney stones, in order to decrease the likelihood of stone formation.
美国约有1000万成年人经历过肾结石发作，多达500万人被医生诊断为痛风。既往报告提示痛风会增加肾结石发病风险，但尚无前瞻性数据。我们利用来自51529名男性医疗保健专业人员队列的数据，研究痛风与肾结石疾病之间的独立关联。在对1986年基线问卷中报告的痛风和肾结石疾病进行横断面分析时，有痛风病史的男性肾结石疾病患病率几乎是无痛风病史男性的两倍（15%对8%）。在调整年龄和体重指数（BMI）后，痛风病史仍与肾结石疾病显著相关（比值比1.88；95%置信区间1.68至2.11）。然后，我们前瞻性地研究了在排除基线问卷中报告有肾结石疾病或痛风病史的男性后，确诊痛风和未确诊痛风的男性发生肾结石的风险。确诊痛风增加了发生肾结石的多变量相对风险（相对风险2.12；95%置信区间1.22至3.68）。相比之下，肾结石疾病病史与痛风风险增加无关（相对风险1.05；95%置信区间0.54至2.07）。总之，痛风病史会独立增加男性发生肾结石的风险。医生除了应对有肾结石家族史等其他风险因素外，还应向痛风患者提供饮食咨询，如增加液体摄入量和减少盐摄入量，以降低结石形成的可能性。
