糖尿病与肾结石风险

Diabetes mellitus and the risk of nephrolithiasis.

作者信息

Taylor Eric N, Stampfer Meir J, Curhan Gary C

机构信息

Channing Laboratory, and Renal Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.

出版信息

Kidney Int. 2005 Sep;68(3):1230-5. doi: 10.1111/j.1523-1755.2005.00516.x.

DOI:10.1111/j.1523-1755.2005.00516.x

PMID:16105055

Abstract

BACKGROUND

Insulin resistance is a central feature of type 2 diabetes mellitus (DM) and may increase the risk of kidney stone formation. Existing cross-sectional data on the association between DM and nephrolithiasis are limited, and no prospective study to date has evaluated the relation between DM and the risk of kidney stones.

METHODS

To evaluate the relation between DM and prevalent kidney stones, we conducted a cross-sectional study of 3 large cohorts including over 200,000 participants: the Nurses' Health Study I (older women), the Nurses' Health Study II (younger women), and the Health Professionals Follow-up Study (men). We then prospectively studied the association between DM and incident nephrolithiasis over a combined 44 years of follow-up. Because insulin resistance can precede the diagnosis of DM by decades, we also prospectively examined the relation between kidney stones and the diagnosis of incident DM. Multivariate regression models adjusted for age, body mass index, thiazide diuretic use, fluid intake, and dietary factors.

RESULTS

At baseline, the multivariate relative risk of prevalent stone disease in individuals with DM compared to individuals without was 1.38 (95% CI 1.06-1.79) in older women, 1.67 (95% CI 1.28-2.20) in younger women, and 1.31 (95% CI 1.11-1.54) in men. Prospectively, the multivariate relative risk of incident kidney stone formation in participants with DM compared to participants without was 1.29 (95% CI 1.05-1.58) in older women, 1.60 (95% CI 1.16-2.21) in younger women, and 0.81 (95% CI 0.59-1.09) in men. The multivariate relative risk of incident DM in participants with a history of kidney stones compared to participants without was 1.33 (95% CI 1.18-1.50) in older women, 1.48 (95% CI 1.14-1.91) in younger women, and 1.49 (95% CI 1.29-1.72) in men.

CONCLUSION

DM is a risk factor for the development of kidney stones. Additional studies are needed to determine if the increased risk of DM in stone formers is due to subclinical insulin resistance.

摘要

背景

胰岛素抵抗是2型糖尿病（DM）的核心特征，可能会增加肾结石形成的风险。现有的关于DM与肾结石之间关联的横断面数据有限，且迄今为止尚无前瞻性研究评估DM与肾结石风险之间的关系。

方法

为了评估DM与现患肾结石之间的关系，我们对3个大型队列（包括超过200,000名参与者）进行了横断面研究：护士健康研究I（老年女性）、护士健康研究II（年轻女性）和卫生专业人员随访研究（男性）。然后，我们在长达44年的联合随访中前瞻性地研究了DM与新发肾结石之间的关联。由于胰岛素抵抗可能在DM诊断前数十年就已出现，我们还前瞻性地研究了肾结石与新发DM诊断之间的关系。多变量回归模型对年龄、体重指数、噻嗪类利尿剂使用、液体摄入量和饮食因素进行了校正。

结果

在基线时，老年女性中患DM者与未患DM者相比，现患结石病的多变量相对风险为1.38（95%可信区间1.06 - 1.79），年轻女性为1.67（95%可信区间1.28 - 2.20），男性为1.31（95%可信区间1.11 - 1.54）。前瞻性研究中，患DM的参与者与未患DM的参与者相比，老年女性新发肾结石形成的多变量相对风险为1.29（95%可信区间1.05 - 1.58），年轻女性为1.60（95%可信区间1.16 - 2.21），男性为0.81（95%可信区间0.59 - 1.09）。有肾结石病史的参与者与无肾结石病史的参与者相比，老年女性新发DM的多变量相对风险为1.33（95%可信区间1.18 - 1.50），年轻女性为1.48（95%可信区间1.14 - 1.91），男性为1.49（95%可信区间1.29 - 1.72）。