尿中三聚氰胺排泄与尿路结石的关系：上海成人病例对照研究。
Urinary Excretion of Cyanuric Acid in Association with Urolithiasis: A Matched Case-Control Study in Shanghai Adults.
机构信息
Key Lab of Public Health Safety of the Ministry of Education, School of Public Health, Fudan University, Shanghai 200032, China.
Department of Urology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
出版信息
Int J Environ Res Public Health. 2022 Jul 18;19(14):8726. doi: 10.3390/ijerph19148726.
Melamine (MEL) has raised human concern since the 2008 milk scandal. Co-exposure to MEL and one of its analogues, cyanuric acid (CYA), has been reported to have a synergistic effect on promoting urolithiasis. However, few epidemiological studies have reported urolithiasis in association with exposure to CYA based on our knowledge. We therefore conducted a case-control study to investigate whether cases of urolithiasis had higher excretion of urinary CYA than the controls. Spot urine samples from 70 adult cases and first-morning urine samples from 70 controls (matched by age and sex) were collected for the measurement of MEL, CYA, and other two analogues in urine. The case group also had 2.81-fold higher concentration of urinary CYA than the control group (34.87 versus 12.43 ng/mL, p-value < 0.001). Multivariate conditional logistic regression models adjusting potential confounders of personal characteristics identified the risk factor of urinary CYA as a continuous variable with odds ratio (OR) (95% confidence interval, 95%CI) of 1.11 (1.02−1.21) (p-value = 0.021) and having meals at restaurants with OR of 5.71 (1.01−32.31) (p-value = 0.049). Compared to the participants having the lowest quartile of CYA concentration in urine, participants at the second, third, and fourth quartile groups had ORs of 13.94, 83.69, and 118.65 with p-values of 0.004, <0.001, and <0.001, respectively. The high excretion of urinary CYA in urolithiasis cases might be the sign of stones in patients consisting of CYA, then proving the attribution of CYA exposure in the etiology of urolithiasis. These findings are important since CYA is a degraded by-product of chlorinated isocyanuric acid disinfectants, which are widely used in daily life not only in swimming pool water but also in other scenarios, such as serving as anti-pandemic disinfectants. Risk assessment of CYA serving as a by-product of disinfectants needs to be conducted in future studies.
三聚氰胺（MEL）自 2008 年牛奶丑闻以来引起了人们的关注。据报道，三聚氰胺和其类似物氰尿酸（CYA）的共同暴露对促进尿结石形成具有协同作用。然而，据我们所知，很少有流行病学研究报告基于 CYA 暴露与尿结石形成有关。因此，我们进行了一项病例对照研究，以调查尿结石患者的尿 CYA 排泄是否高于对照组。收集 70 例成年病例的尿样和 70 例对照者的晨尿样（按年龄和性别匹配），用于检测尿液中的 MEL、CYA 和其他两种类似物。病例组尿 CYA 浓度也比对照组高 2.81 倍（34.87 与 12.43ng/mL，p 值<0.001）。调整个人特征潜在混杂因素的多变量条件逻辑回归模型确定尿 CYA 作为连续变量的危险因素，比值比（OR）（95%置信区间，95%CI）为 1.11（1.02−1.21）（p 值=0.021）和在餐馆就餐的 OR 为 5.71（1.01−32.31）（p 值=0.049）。与尿 CYA 浓度最低四分位数的参与者相比，第二、三、四分位数组的 OR 分别为 13.94、83.69 和 118.65，p 值分别为 0.004、<0.001 和<0.001。结石患者尿中 CYA 排泄量高可能是结石由 CYA 组成的标志，从而证明 CYA 暴露在尿结石发病机制中的作用。这些发现很重要，因为 CYA 是氯化异氰尿酸消毒剂的降解副产物，这种消毒剂不仅在游泳池水中，而且在其他场景（如用作抗疫消毒剂）中广泛应用于日常生活中。在未来的研究中，需要对作为消毒剂副产物的 CYA 进行风险评估。
Zotero 插件