Curhan G C, Willett W C, Rimm E B, Speizer F E, Stampfer M J
Department of Medicine, Brigham and Women's Hospital, Boston, MA 02115, USA.
J Am Soc Nephrol. 1998 Sep;9(9):1645-52. doi: 10.1681/ASN.V991645.
A variety of factors influence the formation of calcium oxalate kidney stones, including gender, diet, and urinary excretion of calcium, oxalate, and uric acid. Several of these factors may be related to body size. Because men on average have a larger body size and a threefold higher lifetime risk of stone formation than women, body size may be an important risk factor for calcium oxalate stone formation. The association between body size (height, weight, and body mass index) and the risk of kidney stone formation was studied in two large cohorts: the Nurses' Health Study (NHS; n = 89,376 women) and the Health Professionals Follow-up Study (HPFS; n = 51,529 men). Information on body size, kidney stone formation, and other exposures of interest was obtained by mailed questionnaires. A total of 1078 incident cases of kidney stones in NHS during 14 yr of follow-up and a total of 956 cases in HPFS during 8 yr of follow-up were confirmed. In both cohorts, the prevalence of a stone disease history and the incidence of stone disease were directly associated with weight and body mass index. However, the magnitude of the associations was consistently greater among women. Specifically, the age-adjusted prevalence odds ratio for women with body mass index > or = 32 kg/m2 compared with 21 to 22.9 kg/m2 was 1.76 (95% confidence interval, 1.50 to 2.07), but 1.38 (95% confidence interval, 1.16 to 1.65) for the same comparison in men. For incident stone formation, the multivariate relative risks for the similar comparisons were 1.89 (1.51 to 2.36) for women and 1.19 (0.83 to 1.70) in men. Height was inversely associated with the prevalence of stone disease but was not associated with incident stone formation. These results suggest that body size is associated with the risk of stone formation and that the magnitude of risk varies by gender. Additional studies are necessary to determine whether a reduction in body weight decreases the risk of stone formation, particularly in women.
多种因素会影响草酸钙肾结石的形成，包括性别、饮食以及钙、草酸盐和尿酸的尿液排泄。这些因素中有几个可能与体型有关。由于男性平均体型较大，患结石的终生风险是女性的三倍，因此体型可能是草酸钙结石形成的一个重要风险因素。在两个大型队列中研究了体型（身高、体重和体重指数）与肾结石形成风险之间的关联：护士健康研究（NHS；n = 89376名女性）和卫生专业人员随访研究（HPFS；n = 51529名男性）。通过邮寄问卷获取有关体型、肾结石形成及其他感兴趣暴露因素的信息。在NHS随访的14年中，共确诊了1078例肾结石新发病例，在HPFS随访的8年中，共确诊了956例。在这两个队列中，结石病史的患病率和结石病的发病率均与体重和体重指数直接相关。然而，女性中的关联程度始终更大。具体而言，体重指数≥32 kg/m²的女性与体重指数为21至22.9 kg/m²的女性相比，年龄调整后的患病比值比为1.76（95%置信区间，1.50至2.07），而男性进行相同比较时该比值比为1.38（95%置信区间，1.16至1.65）。对于新发生的结石形成，类似比较的多变量相对风险在女性中为1.89（1.51至2.36），在男性中为1.19（0.83至1.70）。身高与结石病的患病率呈负相关，但与新发生的结石形成无关。这些结果表明体型与结石形成风险相关，且风险程度因性别而异。有必要进行更多研究以确定体重减轻是否会降低结石形成风险，尤其是在女性中。
