胰腺外分泌功能不全是慢性胰腺炎患者肾结石的一个危险因素。

Pancreatic exocrine insufficiency is a risk factor for kidney stones in patients with chronic pancreatitis.

作者信息

Vujasinovic Miroslav, Dugic Ana, Thiel Tomas, Kjellman Anders, Yang Caroline, Löhr J-Matthias

机构信息

Department of Upper Abdominal Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.

Department of Medicine, Huddinge, Karolinska Institute, Stockholm, Sweden.

出版信息

Pancreatology. 2023 Apr;23(3):294-298. doi: 10.1016/j.pan.2023.03.006. Epub 2023 Mar 22.

DOI:10.1016/j.pan.2023.03.006

PMID:36990843

Abstract

INTRODUCTION

Most patients with chronic pancreatitis (CP) develop pancreatic exocrine insufficiency (PEI) over the course of the disease. PEI may lead to hyperoxaluria and development of urinary oxalate stones. It has been postulated that the patients with CP may be at increased risk of kidney stone formation, but the data is scarce. We aimed to estimate incidence and risk factors for nephrolithiasis in a Swedish cohort of patients with CP.

PATIENTS AND METHODS

We performed retrospective analysis of an electronical medical database of patients diagnosed with definite CP during 2003-2020. We excluded patients <18 years of age, those with missing relevant data in medical charts, patients with probable CP (according to the M-ANNHEIM classification system) and those in whom kidney stones were diagnosed before CP diagnosis.

RESULTS

Some 632 patients with definite CP were followed over a median of 5.3 (IQR 2.4-6.9) years. There were 41 (6.5%) patients diagnosed with kidney stones, of whom 33 (80.5%) were symptomatic. Comparing to patients without kidney stones, patients with nephrolithiasis were older, with median age of 65 (IQR 51-72) years, and a male predominance (80% vs 63%). Cumulative incidence of kidney stones was 2.1%, 5.7%, 12.4% and 16.1% at 5, 10, 15, and 20 years after CP diagnosis, respectively. Multivariable cause-specific Cox regression analysis revealed PEI as independent risk factor for nephrolithiasis (adjusted HR 4.95, 95%CI 1.65-14.84; p = 0.004). Another risk factors were increase in BMI (aHR 1.16 95% CI 1.04-1.30; p = 0.001 per unit increment), and a male sex (4.51, 95% CI 1.01-20.3, p = 0.049).

CONCLUSION

PEI and increase in BMI are risk factors for kidney stone development in patients with CP. Male CP patents are particularly at increased risk of nephrolithiasis. This should be taken into consideration in general clinical approach to raise awareness among patients and medical workers.

摘要

引言

大多数慢性胰腺炎（CP）患者在疾病过程中会出现胰腺外分泌功能不全（PEI）。PEI可能导致高草酸尿症和尿路草酸钙结石的形成。据推测，CP患者肾结石形成的风险可能增加，但相关数据较少。我们旨在评估瑞典CP患者队列中肾结石的发病率及危险因素。

患者与方法

我们对2003年至2020年期间确诊为明确CP的患者的电子医疗数据库进行了回顾性分析。我们排除了年龄<18岁的患者、病历中缺少相关数据的患者、可能患有CP的患者（根据M-ANNHEIM分类系统）以及在CP诊断前就已诊断出肾结石的患者。

结果

约632例明确患有CP的患者接受了中位时间为5.3（四分位间距2.4 - 6.9）年的随访。有41例（6.5%）患者被诊断出患有肾结石，其中33例（80.5%）有症状。与无肾结石的患者相比，肾结石患者年龄更大，中位年龄为65岁（四分位间距51 - 72岁），且以男性为主（80%对63%）。CP诊断后5年、10年、15年和20年时肾结石的累积发病率分别为2.1%、5.7%、12.4%和16.1%。多变量特定病因Cox回归分析显示，PEI是肾结石的独立危险因素（调整后风险比4.95，95%置信区间1.65 - 14.84；p = 0.004）。其他危险因素包括体重指数增加（每单位增量的调整后风险比1.16，95%置信区间1.04 - 1.30；p = 0.001）和男性（4.51，95%置信区间1.01 - 20.3，p = 0.049）。