Maloney Michaella E, Springhart W Patrick, Ekeruo Wesley O, Young Matthew D, Enemchukwu Chibuzo U, Preminger Glenn M
Comprehensive Kidney Stone Center, Division of Urology, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA.
J Urol. 2005 Jun;173(6):2001-4. doi: 10.1097/01.ju.0000159076.70638.1e.
Nephrolithiasis disproportionately affects white patients. However, recent studies propose an increase in the incidence of stone disease in nonwhite populations. We compared the metabolic risk factors of ethnically disparate stone formers from the same geographic region.
A retrospective review of 1,141 patients identified 98 (9%) nonwhite stone formers. Of these individuals 60 underwent a comprehensive metabolic evaluation, comprising 44 black, 8 Asian and 8 Hispanic patients. A similar sex and age matched group of 66 white stone forming patients were also identified for comparative analysis. Stone analyses were recorded when available. Urinary metabolic abnormalities were defined as low urine volume-urine volume less than 2,000 cc, gouty diathesis-pH 5.5 or less (normal level 5.5 to 6.5), hypercalciuria-calcium greater than 200 mg, hyperoxaluria-oxalate greater than 45 mg, hyperuricosuria-uric acid greater than 600 mg, hypocitraturia-citrate less than 600 mg and purine gluttony-sulfate greater than 20 mg.
The incidence of metabolic abnormalities was surprisingly similar between the white and nonwhite stone formers. Whites have a higher prevalence of hypercalciuria compared with nonwhites (67% vs 25%, respectively, p <0.01). This comparison persisted when the white group was compared with individual ethnic groups (25% in each group). Whites also displayed a higher mean urinary calcium level (233 mg) than their nonwhite counterparts overall (146 mg), specifically with respect to blacks (146 mg, p <0.01). Asians had higher urine volumes with respect to whites and blacks (p <0.01) and, therefore, a decreased prevalence of low urine volumes (37.5% vs 74.2% and 79.5%, respectively). Hypocitraturia, hyperuricosuria, hyperoxaluria, gouty diathesis and high sulfate levels were equally represented among all ethnic groups.
Although there appears to be a predominance of stone disease among whites, all racial groups demonstrated a remarkable similarity in the incidence of underlying metabolic abnormalities. These results suggest that dietary and environmental factors may be as important as ethnicity in the etiology of stone disease.
肾结石在白人患者中的影响尤为突出。然而，最近的研究表明非白人人群中结石病的发病率有所上升。我们比较了来自同一地理区域、不同种族的结石形成者的代谢危险因素。
对1141例患者进行回顾性研究，确定了98例（9%）非白人结石形成者。其中60例接受了全面的代谢评估，包括44例黑人、8例亚洲人和8例西班牙裔患者。还确定了一组年龄和性别匹配的66例白人结石形成患者进行对比分析。如有结石分析结果，则予以记录。尿液代谢异常的定义为：低尿量——尿量少于2000毫升；痛风素质——pH值5.5或更低（正常范围5.5至6.5）；高钙尿症——钙含量大于200毫克；高草酸尿症——草酸盐含量大于45毫克；高尿酸尿症——尿酸含量大于600毫克；低枸橼酸尿症——枸橼酸盐含量小于600毫克；嘌呤摄入过多——硫酸盐含量大于20毫克。
白人和非白人结石形成者之间代谢异常的发生率惊人地相似。白人高钙尿症的患病率高于非白人（分别为67%和25%，p<0.01）。当将白人组与各个种族群体进行比较时，这种差异依然存在（每组均为25%）。总体而言，白人的平均尿钙水平（233毫克）也高于非白人（146毫克），特别是与黑人相比（146毫克，p<0.01）。与白人和黑人相比，亚洲人的尿量更多（p<0.01），因此低尿量的患病率较低（分别为37.5%、74.2%和79.5%）。低枸橼酸尿症、高尿酸尿症、高草酸尿症、痛风素质和高硫酸盐水平在所有种族群体中的表现相当。
尽管白人中结石病似乎更为常见，但所有种族群体潜在代谢异常的发生率都非常相似。这些结果表明，在结石病的病因中，饮食和环境因素可能与种族同样重要。
