腎結石與主動脈鈣化高風險有關


  【24drs.com】一篇回溯研究認為,相較於沒有發生腎結石的人,患有鈣性腎結石的患者,發生腹主動脈鈣化(AAC)的風險比較高,且脊椎骨質密度(BMD)降低。
  
  這篇研究線上發表於1月29日美國腎臟學會臨床期刊。
  
  英國倫敦大學院醫學院皇家自由醫院院區的Linda Shavit醫師等人發現,腹主動脈鈣化盛行率在腎結石患者(38%)與沒有結石的對照組患者(35%)相似;不過,有腎結石者(KSFs)中,68%有中到嚴重的腹主動脈鈣化,無腎結石者對照組則只有26% (P < .001)。
  
  根據電腦斷層(CT)分析骨質密度,曾患腎結石之患者測得數值為159 Hounsfield單位,也顯著低於無腎結石者測得的194 Hounsfield單位(P <.001)。
  
  作者們觀察發現,使用電腦斷層掃描測量腹主動脈鈣化,是考慮到它是心血管相關發病率或死亡的強力預測因子,我們的研究用來測量結石患者與健康對照組的血管鈣化負擔。
  
  多變項分析校正所有潛在的共變項,確認腎結石與血管鈣化的嚴重類型具有獨立關聯。
  
  研究者進行一項回溯配對案例控制研究,納入2011-2014年間、於英國倫敦皇家自由醫院腎臟科門診就醫的腎結石患者進行研究。
  
  研究者從該醫院的潛在活體腎臟捐贈者名單中,配對年齡和性別相仿的非結石者,研究對象共111人,57名患有腎結石、54名健康對照組,兩組的平均年齡都是47歲。
  
  腹主動脈鈣化與脊椎骨質密度都是使用電腦斷層掃描測量,腹主動脈鈣化嚴重度分數(以中位數[25th、75th]代表),腎結石組都顯著高於對照組(0 [0、43]相較於0 [0, 10];P < .001)。
  
  多變項模式校正了年齡、性別、高血壓、糖尿病、抽菸、估計腎絲球過濾速率等,腎結石者與無腎結石者的腹主動脈鈣化分數差異是3.78單位(P < .001);同樣地,在這個多變項模式中,兩組電腦斷層的骨質密度分析差異為-35.88 Hounsfield單位(P < .001)。
  
  腹主動脈鈣化分數較高也與腎結石患者及無腎結石患者的骨質密度較低有強烈關聯(P < .001)。
  
  研究者寫道,我們的研究顯示,鈣性腎結石患者的主動脈鈣化比率顯著高於年齡性別相仿的無結石者,表示血管鈣化是可以用來解釋腎結石和[心血管疾病]之關聯的潛在機轉。
  
  波特蘭緬因醫學中心的Eric Taylor醫師在編輯評論中指出,這篇研究對於醫界瞭解鈣性腎結石、骨質密度較低與心血管疾病之間的關聯代表著一個重要的貢獻。
  
  如同Taylor所指出的,腹主動脈鈣化是相關研究指標,與冠狀動脈鈣化正相關,非致死性和致死性冠狀動脈心臟疾病事件的一個既定預測因子。
  
  Taylor醫師表示,相對的,這篇研究並未闡釋機制,從而引發的問題多於答案。同時,執業腎臟科醫師會有疑惑:研究的現狀會如何影響鈣結石患者目前的照護。
  
  目前還無法將有結石病史整合到骨質疏鬆症或心血管疾病風險的篩檢指引,Taylor醫師指出,不過,精明的醫生們很清楚,最好的療法往往不是最新或最複雜的。鼓勵人們多吃水果、蔬菜與全穀類,減少紅肉與精製肉類和汽水,永遠都是好時機。
  
  資料來源:http://www.24drs.com/

Kidney Stones Linked to Higher Risk for Aortic Calcification

By Pam Harrison
Medscape Medical News

Patients who form calcium kidney stones are more likely to have higher abdominal aortic calcification (AAC) and lower vertebral bone mineral density (BMD) scores than those who do not develop kidney stones, a retrospective study suggests.

The study was published online January 29 in the Clinical Journal of the American Society of Nephrology.

Linda Shavit, MD, from the Royal Free Campus and Hospital, University College London Medical School, United Kingdom, and colleagues found that the prevalence of AAC was similar in patients who formed kidney stones (38%) compared with in non–stone forming control patients (35%).

However, 68%, of kidney stone formers (KSFs) had moderate to severe AAC scores compared with only 26% of non–stone forming controls (P < .001).

The average BMD, as assessed by computed tomography (CT), was also significantly lower, at 159 Hounsfield units in patients with a history of kidney stones compared with 194 Hounsfield units for those who did not (P < .001).

"[AAC] measured by CT scan is considered as a strong predictor of CV-related morbidity or death and was used in our study as a measure of [vascular calcification] burden in KSF and healthy control patients," the authors observe.

"[M]ultivariate analyses adjusted for all potential confounders confirmed that kidney stone disease is independently associated with advanced forms of [vascular calcification] compared with non-KSF."

Investigators carried out a retrospective matched case-control study that included KSFs attending the outpatient nephrology clinic of the Royal Free Hospital in London, United Kingdom, between 2011 and 2014.

The researchers drew age- and sex-matched non–stone formers from a list of potential living kidney donors from the same hospital. They investigated a total of 111 patients, 57 of whom were KSFs and 54 of whom were healthy controls. The mean age of both groups was 47 years.

AAC and vertebral BMD were assessed using CT imaging. AAC severity scores (presented as median [25th, 75th]) were significantly higher at in the KSF group compared with controls (0 [0, 43] vs 0 [0, 10]; P < .001).

The difference in AAC scores on multivariate models adjusted for age sex, high blood pressure, diabetes, smoking status, and estimated glomerular filtration rate was 3.78 units between KSF and non–stone formers (P < .001).

Similarly, the difference between the two groups on CT measures of BMD in the same multivariate model was ?35.88 Hounsfield units (P < .001).

A higher AAC score also strongly correlated with lower BMD in both KSFs and non–stone formers (P < .001).

"Our study demonstrates that patients with calcium kidney stones suffer from significantly higher degrees of aortic calcification than age- and sex-matched non-stone formers," the investigators write, "suggesting that [vascular calcification] may be an underlying mechanism explaining reported associations between nephrolithiasis and [cardiovascular disease]."

Important Contribution

In an accompanying editorial, Eric Taylor, MD, from the Maine Medical Center, Portland, notes that the study represents "an important contribution" to the medical community's understanding of the potential relationships among calcium nephrolithiasis, lower BMD, and cardiovascular disease.

As Dr Taylor points out, AAC is a relevant study metric, being positively correlated with coronary artery calcification, an established predictor of incident nonfatal and fatal coronary heart disease.

In contrast, the study was not designed to elucidate mechanisms, and thus raises more questions than answers, Dr Taylor suggests.

"In the meantime, practicing nephrologists are left to wonder how the current state of research may affect the care of the patient with recurrent calcium stone disease," he writes.

It is still too early to incorporate a history of stone formation into current screening guidelines for either osteoporosis or CVD risk factors. "However, the savvy clinician is well aware that often the best therapies are not the newest or most complicated," Dr Taylor notes. "Perhaps it is always the right time to encourage a healthy diet with more fruits, vegetables, and whole grains and less red and processed meats and soda."

One coauthor is currently on secondment as a Chief Scientist with AstraZeneca. The other authors and Dr Taylor have disclosed no relevant financial relationships.

Clin J Am Soc Nephrol. Published online January 29, 2015.

    
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