Dharmsathaphorn K, Freeman D H, Binder H J, Dobbins J W
Dig Dis Sci. 1982 May;27(5):401-5. doi: 10.1007/BF01295647.
Patients with ileal disease have increased absorption of dietary oxalate, hyperoxaluria, and an increased incidence of nephrolithiasis. Patients with steatorrhea of varying etiologies also have hyperoxaluria. To determine whether steatorrhea per se is associated with nephrolithiasis, we reviewed the charts of all adult patients who had a 72-hr fecal fat analysis from 1968 to 1978. The 159 patients with steatorrhea were compared to 162 patients without steatorrhea. The two groups were comparable in age, sex, urine specific gravity, and serum uric acid and phosphorus; serum calcium was slightly less in the steatorrhea group (8.7 +/- 0.1 vs 9.0 +/- 0.1, P less than 0.02). Although 19 patients with steatorrhea had nephrolithiasis compared to 7 control patients (P = 0.01), 15 of these 19 patients had ileal disease and only 4 of the 118 patients with steatorrhea but without ileal disease had stones. Categorical data analysis revealed that steatorrhea, diarrhea (stool weight greater than 225 g/day), male sex, and ileal disease were significantly associated with nephrolithiasis with a relative risk of 3.0, 2.7, 3.1, and 8.0, respectively. When patients without ileal disease were analyzed separately, however, steatorrhea, diarrhea, and sex were no longer risk factors. In contrast, in patients with ileal disease the incidence of nephrolithiasis increased with the severity of steatorrhea. The relative risk of nephrolithiasis in male patients with ileal disease and fecal fat greater than 20 g/day was 26.3 (P less than 0.01). Thus, the presence of both ileal disease and steatorrhea greatly increases the risk of nephrolithiasis; however, neither steatorrhea alone nor ileal disease alone are risk factors for nephrolithiasis.
患有回肠疾病的患者饮食草酸盐吸收增加、高草酸尿症以及肾结石发病率增加。病因各异的脂肪泻患者也有高草酸尿症。为了确定脂肪泻本身是否与肾结石有关，我们查阅了1968年至1978年期间所有进行了72小时粪便脂肪分析的成年患者的病历。将159例脂肪泻患者与162例无脂肪泻患者进行比较。两组在年龄、性别、尿比重、血清尿酸和磷方面具有可比性；脂肪泻组的血清钙略低（8.7±0.1 vs 9.0±0.1，P<0.02）。虽然19例脂肪泻患者患有肾结石，而对照组为7例患者（P = 0.01），但这19例患者中有15例患有回肠疾病，118例有脂肪泻但无回肠疾病的患者中只有4例有结石。分类数据分析显示，脂肪泻、腹泻（粪便重量>225克/天）、男性和回肠疾病与肾结石显著相关，相对风险分别为3.0、2.7、3.1和8.0。然而，当单独分析无回肠疾病的患者时，脂肪泻、腹泻和性别不再是危险因素。相比之下，在患有回肠疾病的患者中，肾结石的发病率随着脂肪泻的严重程度而增加。回肠疾病且粪便脂肪>20克/天的男性患者患肾结石的相对风险为26.3（P<0.01）。因此，回肠疾病和脂肪泻同时存在会大大增加患肾结石的风险；然而，单独的脂肪泻或单独的回肠疾病都不是肾结石的危险因素。
