Glickman Urology and Kidney Institute, and Imaging Institute (RDW, EMR), Cleveland Clinic Foundation, Cleveland, Ohio.
Glickman Urology and Kidney Institute, and Imaging Institute (RDW, EMR), Cleveland Clinic Foundation, Cleveland, Ohio.
J Urol. 2017 Nov;198(5):1085-1090. doi: 10.1016/j.juro.2017.05.079. Epub 2017 Jun 3.
Uric acid nephrolithiasis is associated with an elevated visceral fat area in kidney stone formers. Hepatic steatosis has also been linked to visceral obesity and nephrolithiasis. We evaluated the association of noncontrast computerized tomography based diagnosis of visceral obesity and hepatic steatosis with 24-hour urine parameters and stone composition in kidney stone formers.
A total of 98 kidney stone formers were included in study who had computerized tomography imaging and 24-hour urine studies available. For each patient a single computerized tomography axial area measurement was obtained of the visceral fat area. Hepatic steatosis was diagnosed by comparing the HU of regions from the liver and spleen. Univariate analysis was performed to compare patients with or without an elevated visceral fat area and hepatic steatosis. Multivariate linear and logistic regression was done to assess for variables associated with 24-hour urine parameters and stone composition.
An elevated visceral fat area was associated with higher 24-hour urine sodium (175 vs 157 mg per day, p <0.036) and lower 24-hour urine pH (5.724 vs 6.478, <0.0001). Urine pH less than 6 (OR 2.52) was associated with hepatic steatosis. Low urine pH less than 6 (OR 11.1, p = 0.004) and stone volume greater than 65 mm (OR 5.12, p = 0.023) were associated with an elevated visceral fat area. Low urine pH less than 6 (OR 5.87) and visceral fat area greater than 48% (OR 5.33) were associated with uric acid stones. Linear regression demonstrated that the percent of visceral fat area was associated with lower 24-hour urine pH (β-coefficient -0.438, p <0.0001).
Noncontrast computerized tomography based diagnosis of visceral obesity is associated with low urine pH, high urinary sodium and uric acid stone formation. Hepatic steatosis is associated with low urine pH.
尿酸肾结石与肾结石患者内脏脂肪面积升高有关。肝脂肪变性也与内脏肥胖和肾结石有关。我们评估了非对比计算机断层扫描（CT）诊断的内脏肥胖和肝脂肪变性与肾结石患者 24 小时尿液参数和结石成分的相关性。
本研究共纳入 98 例肾结石患者，均行 CT 成像和 24 小时尿液研究。对每位患者进行单次 CT 轴位内脏脂肪面积测量。通过比较肝脏和脾脏区域的 HU 值来诊断肝脂肪变性。对有或无内脏脂肪面积升高和肝脂肪变性的患者进行单变量分析。进行多元线性和逻辑回归分析，以评估与 24 小时尿液参数和结石成分相关的变量。
内脏脂肪面积升高与 24 小时尿钠量较高（175 比 157mg/天，p<0.036）和 24 小时尿 pH 值较低（5.724 比 6.478，<0.0001）相关。尿 pH 值小于 6（OR 2.52）与肝脂肪变性相关。低尿 pH 值小于 6（OR 11.1，p=0.004）和结石体积大于 65mm（OR 5.12，p=0.023）与内脏脂肪面积升高相关。低尿 pH 值小于 6（OR 5.87）和内脏脂肪面积大于 48%（OR 5.33）与尿酸结石相关。线性回归显示，内脏脂肪面积百分比与 24 小时尿 pH 值较低相关（β 系数-0.438，p<0.0001）。
非对比 CT 诊断的内脏肥胖与低尿 pH 值、高尿钠和尿酸结石形成有关。肝脂肪变性与低尿 pH 值有关。
