Letavernier Emmanuel, Vandermeersch Sophie, Traxer Olivier, Tligui Mohamed, Baud Laurent, Ronco Pierre, Haymann Jean-Philippe, Daudon Michel
From the Sorbonne universités-UPMC Univ Paris 06 (EL, SV, OT, LB, PR, J-PH, MD); INSERM UMR S 1155 (EL, SV, LB, PR, J-PH, MD); AP-HP (EL, LB, J-PH, MD), Hôpital Tenon, Explorations fonctionnelles multidisciplinaires and Cristal Laboratory; AP-HP (OT, MT), Hôpital Tenon, Service d'Urologie; and AP-HP (PR), Hôpital Tenon, Service de Nephrologie, Paris, France.
Medicine (Baltimore). 2015 Mar;94(10):e566. doi: 10.1097/MD.0000000000000566.
Renal stone incidence has progressively increased in industrialized countries, but the implication of Randall plaque in this epidemic remains unknown. Our objectives were to determine whether the prevalence of Randall plaque-related stones increased during the past decades after having analyzed 30,149 intact stones containing mainly calcium oxalate since 1989 (cross-sectional study), and to identify determinants associated with Randall plaque-related stones in patients (case-control study). The proportion of Randall plaque-related stones was assessed over 3 time periods: 1989-1991, 1999-2001, and 2009-2011. Moreover, we analyzed clinical and biochemical parameters of 105 patients affected by calcium oxalate stones, with or without plaque. Of 30,149 calcium oxalate stones, 10,282 harbored Randall plaque residues (34.1%). The prevalence of Randall plaque-related stones increased dramatically during the past years. In young women, 17% of calcium oxalate stones were associated with Randall plaque during the 1989-1991 period, but the proportion rose to 59% 20 years later (P < 0.001). Patients with plaques experienced their first stone-related event earlier in life as compared with those without plaque (median age 26 vs 34 years, P = 0.02), had increased ionized serum calcium levels (P = 0.04), and increased serum osteocalcin (P = 0.001) but similar 25-hydroxyvitamin D levels. The logistic regression analysis showed that age (odds ratio [OR] 0.96, confidence interval [CI] 0.926-0.994, P = 0.02), weight (OR 0.97, CI 0.934-0.997, P = 0.03), and osteocalcin serum levels (OR 1.12, CI 1.020-1.234, P = 0.02) were independently associated with Randall plaque. The prevalence of the FokI f vitamin D receptor polymorphism was higher in patients with plaque (P = 0.047). In conclusion, these findings point to an epidemic of Randall plaque-associated renal stones in young patients, and suggest a possible implication of altered vitamin D response.
在工业化国家，肾结石的发病率呈逐渐上升趋势，但兰德尔斑在这一流行趋势中的作用仍不清楚。我们的目标是，在分析了自1989年以来的30149颗主要为草酸钙的完整结石后（横断面研究），确定过去几十年中与兰德尔斑相关的结石的患病率是否增加，并在患者中识别与兰德尔斑相关结石有关的决定因素（病例对照研究）。在三个时间段评估了与兰德尔斑相关的结石的比例：1989 - 1991年、1999 - 2001年和2009 - 2011年。此外，我们分析了105例患有草酸钙结石、有或无斑块的患者的临床和生化参数。在30149颗草酸钙结石中，10282颗含有兰德尔斑残留物（34.1%）。在过去几年中，与兰德尔斑相关的结石的患病率急剧上升。在年轻女性中，1989 - 1991年期间，17%的草酸钙结石与兰德尔斑有关，但20年后这一比例上升至59%（P<0.001）。与无斑块的患者相比，有斑块的患者在生命早期经历了首次与结石相关的事件（中位年龄26岁对34岁，P = 0.02），血清离子钙水平升高（P = 0.04），血清骨钙素升高（P = 0.001），但25 - 羟基维生素D水平相似。逻辑回归分析显示，年龄（比值比[OR]0.96，置信区间[CI]0.926 - 0.994，P = 0.02）、体重（OR 0.97，CI 0.934 - 0.997，P = 0.03）和血清骨钙素水平（OR 1.12，CI 1.020 - 1.234，P = 0.02）与兰德尔斑独立相关。有斑块的患者中FokI f维生素D受体多态性的患病率较高（P = 0.047）。总之，这些发现表明年轻患者中与兰德尔斑相关的肾结石呈流行趋势，并提示维生素D反应改变可能起作用。
