Kang Ho Won, Seo Sung Pil, Kim Won Tae, Kim Yong-June, Yun Seok-Joong, Lee Sang-Cheol, Kim Wun-Jae
Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.
Department of Urology, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.
Urology. 2014 Oct;84(4):766-71. doi: 10.1016/j.urology.2014.06.013. Epub 2014 Aug 6.
To assess the influence of dyslipidemia on urinary lithogenic metabolites and stone recurrence in stone formers.
We retrospectively selected 321 patients with urolithiasis who had been followed up for >24 months between 2004 and 2009. Fasting blood samples were taken, and serum lipid profiles were measured. All subjects also underwent 24-hour urinary metabolic evaluation and stone analysis. The radiographic appearance of new stones was defined as stone recurrence.
There was no significant correlation between lipid profiles and 24-hour urine metabolites (all P >.05). Stone formers with hypertriglyceridemia had significantly higher urinary calcium, sodium, uric acid, magnesium, and potassium excretions. Only in a subgroup of uric acid stone, hypertriglyceridemia was significantly associated with decreased urinary pH. Those with low high-density lipoprotein (HDL) cholesterolemia had higher urinary sodium, magnesium, and potassium excretions, whereas those with high low-density lipoprotein (LDL) cholesterolemia had lower urinary sodium excretion. Stone analysis revealed that uric acid stones were more commonly found in patients with hypertriglyceridemia and low-HDL cholesterolemia. After a median follow-up of 35.0 months, 109 patients (34% of cohort) had stone recurrence. Stone recurrence was more common in the hypertriglyceridemia group compared with the normal triglyceridemia group (45.9% vs 29.7%; P = .005). The multivariate Cox regression model revealed that hypertriglyceridemia is associated independently with stone recurrence (hazard ratio, 1.857; 95% confidence interval, 1.211-2.847; P = .005). Kaplan-Meier curves showed similar results.
Our study showed that serum lipid profile is associated with urine metabolic alterations. More importantly, hypertriglyceridemia is independently associated with increased risk for stone recurrence in patients with urolithiasis.
评估血脂异常对结石形成者尿石生成代谢产物及结石复发的影响。
我们回顾性选取了2004年至2009年间随访时间超过24个月的321例尿石症患者。采集空腹血样，检测血脂谱。所有受试者还进行了24小时尿代谢评估及结石分析。新结石的影像学表现定义为结石复发。
血脂谱与24小时尿代谢产物之间无显著相关性（所有P>.05）。高甘油三酯血症的结石形成者尿钙、钠、尿酸、镁和钾排泄显著增加。仅在尿酸结石亚组中，高甘油三酯血症与尿pH降低显著相关。高密度脂蛋白（HDL）胆固醇血症低者尿钠、镁和钾排泄较高，而低密度脂蛋白（LDL）胆固醇血症高者尿钠排泄较低。结石分析显示，尿酸结石在高甘油三酯血症和低HDL胆固醇血症患者中更常见。中位随访35.0个月后，109例患者（队列的34%）出现结石复发。与正常甘油三酯血症组相比，高甘油三酯血症组结石复发更常见（45.9%对29.7%；P=.005）。多变量Cox回归模型显示，高甘油三酯血症与结石复发独立相关（风险比，1.857；95%置信区间，1.211 - 2.847；P=.005）。Kaplan-Meier曲线显示了类似结果。
我们的研究表明，血脂谱与尿代谢改变相关。更重要的是，高甘油三酯血症与尿石症患者结石复发风险增加独立相关。
