田纳西州的尿路结石病：了解一个地区性问题的职业窗口。
Urolithiasis in Tennessee: an occupational window into a regional problem.
作者信息
Thun M J, Schober S
机构信息
National Institute for Occupational Safety and Health, Cincinnati, Ohio.
出版信息
Am J Public Health. 1991 May;81(5):587-91. doi: 10.2105/ajph.81.5.587.
BACKGROUND
Urinary tract stones (stones) are believed to be unusually common in the southeastern United States but neither the incidence of nor the risk factors for stones are known.
METHODS
In three well-defined occupational populations in eastern Tennessee, we assessed the prevalence, incidence, and cumulative incidence of stones and measured biochemical risk factors for lithogenesis.
RESULTS
The age-adjusted prevalence of stones was 18.5 percent in Tennessee compared to 7.7 percent among White males in US NHANES (prevalence ratio 2.4, 95% CI 1.7, 3.3). The cumulative incidence (risk) was 27.8 percent by age 65, higher than in any other reported population. Risk factors were age, a family history, and urinary saturation with calcium-oxalate (COAX). Persons with a positive family history and the highest measured CAOX index had a predicted lifetime risk of 88.8 percent. Biochemical factors affecting lithogenesis were hypercalciuria, hyperoxaluria, and low urine volume.
CONCLUSION
Future research should characterize the geographic boundaries of a southeastern "stone-belt" and explore genetic and dietary hypotheses that might explain it.
背景
尿路结石在美国东南部被认为异常常见，但结石的发病率和危险因素均不为人所知。
方法
在田纳西州东部三个明确界定的职业人群中，我们评估了结石的患病率、发病率和累积发病率，并测量了结石形成的生化危险因素。
结果
田纳西州经年龄调整的结石患病率为18.5%，相比之下，美国国家健康和营养检查调查（NHANES）中的白人男性患病率为7.7%（患病率比为2.4，95%置信区间为1.7至3.3）。到65岁时的累积发病率（风险）为27.8%，高于其他任何已报道的人群。危险因素包括年龄、家族史以及草酸钙（COAX）尿液饱和度。有家族史且测量的CAOX指数最高的人预测终生风险为88.8%。影响结石形成的生化因素包括高钙尿症、高草酸尿症和低尿量。
结论
未来的研究应确定东南部“结石带”的地理边界，并探索可能对此作出解释的遗传和饮食假说。
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