Statins類藥物可能可以預防腎結石


  【24drs.com】根據一篇回溯研究,高血脂症患者中,statins類藥物可能可以降低腎結石形成風險。但是,某些專家認為,這篇結果還不足以用來促成預防性使用降血脂藥物。
  
  芝加哥大學醫學中心泌尿科醫師Andrew Cohen在美國泌尿科協會2016年會中表示,這項研究是及時的。他在記者會中向記者們表示,血中脂質程度、服用statin類藥物、慢性腎病、腎結石之間的關聯,在目前廣被研究與辯論。
  
  之前認為脂質上升與腎結石有關,一篇有57,000名新診斷有高血脂症患者的研究首度指出,使用statin類藥物者發生結石的風險低於未使用者(Clin Nephrol. 2013;79:351-355)。
  
  所以,Cohen醫師與北岸大學醫療系統(共有超過100個地點)的研究夥伴決定進行一篇大型研究以確認這些保護效果。
  
  研究團隊使用電子病歷系統回顧在2009-2011年間診斷有高血脂症的101,250名患者的資料,這些患者在診斷時都未曾用過statin類藥物。追蹤這些患者直到2015年,研究的初級終點是發生腎結石。
  
  約半數(48%)研究對象後來有使用statin類藥物,約半數(52%)未使用。
  
  單一變項分析中,statin類藥物使用者發生新結石的機率顯著低於未使用者(3.8% vs 4.7%;P< .01)。
  
  校正年齡、種族、身體質量指數(BMI)、性別、共病症後,多變項分析確認了statin類藥物對於新發生結石的保護效果(勝算比[OR]為0.57;P< .01)。
  
  某些研究對象在發生高血脂症之前曾有腎結石病史。值得注意的是,多變項分析指出,statin類藥物在這些有結石病史患者的保護效果,大於那些有結石病史但沒有statin類藥物處方者(OR, 0.53;P< .01)。Cohen醫師報告指出,這個風險實質上減少了一半。
  
  多變項分析是必要的,因為,其他差異化之中,沒有被處方statin類藥物的患者比未使用者更年輕(51.9 vs 60.7歲;P< .01)且較不肥胖(28.1 vs 29.2kg/m2;P< .01)。
  
  值得注意的是,在追蹤期間,statin類藥物使用者的低密度脂蛋白值和總膽固醇值顯著低於未使用者,這代表有遵醫囑使用藥物。
  
  Cohen醫師強調這個研究結果,因為之前有關此一主題的研究缺乏檢驗數字分析,他表示,這些檢驗資料對我們的研究結果增添了高度可信度。
  
  他指出,這篇研究也確認了發生結石的其他風險,例如:過重、黑人、年長、有骨質疏鬆、有thiazide處方。
  
  他報告指出,當研究者探討血中脂質和未來腎結石風險的關聯時,只有三酸甘油脂上升被證明是未使用statin類藥物者發生結石的風險因素,低密度脂蛋白值或總膽固醇值上升和腎結石無關。
  
  這篇研究也有一些限制。Cohen醫師解釋,當患者們知道他們有高血脂症時,他們可能會改變他們的飲食或生活型態,此外,高膽固醇值往往是略高而不是非常高,因此,這些結果可能無法應用到數值非常高的患者。
  
  但是,匹茲堡大學泌尿科醫師、主持記者會的Timothy Avench醫師表示,這篇研究的結論 — statin類藥物對預防高血脂症成人形成腎結石有保護效果 — 在目前依舊是個學術問題。
  
  他表示,這些結果即使加上2013年研究的結果,還不足以促成預防性使用statin類藥物,在實務上要實現這一點,將需要很大的力量。
  
  資料來源:http://www.24drs.com/
  
  Native link:Statins May Protect Against Kidney Stones

Statins May Protect Against Kidney Stones

By Nick Mulcahy
Medscape Medical News

SAN DIEGO — In patients with hyperlipidemia, statins might reduce the risk for kidney stone formation, according to a retrospective study. But, for some experts, the results are not enough to prompt the prophylactic use of the lipid-lowering drugs.

The study is timely, lead author Andrew Cohen, MD, a urologist from the University of Chicago Medical Center, said here at the American Urological Association 2016 Annual Meeting.

"The relation between levels of lipids in the blood, the intake of statins, chronic kidney disease, and kidney stones is being researched and debated currently," he told reporters during a press conference.

Elevated lipid levels have previously been associated with kidney stones. A study of 57,000 patients newly diagnosed with hyperlipidemia, showed, for the first time, that the risk for stone development was lower in statin users than nonusers (Clin Nephrol. 2013;79:351-355).

So Dr Cohen and his colleagues at the North Shore University Health System (which has more than 100 locations) decided to conduct a larger study to confirm these protective effects.

The team used the electronic medical records system to review data on more than 101,250 patients diagnosed with hyperlipidemia from 2009 to 2011 who were statin-naive at diagnosis. The patients were followed until 2015. The primary end point of the study was the development of kidney stones.

About half (48%) the population subsequently received a statin and about half (52%) did not.

On univariate analysis, the statin users were significantly less likely to develop new stones than the nonusers (3.8% vs 4.7%; P< .01).

Multivariate analysis, adjusted for age, race, body mass index (BMI), sex, and comorbidities, confirmed the protective effect of statins on new stones (odds ratio [OR], 0.57; P< .01).

Some of the study participants had a history of kidney stones before they developed hyperlipidemia. Notably, multivariate analysis indicated that the protective effect of statins was even greater in these patients than in patients with a history of stones but no statin prescription (OR, 0.53; P< .01). The risk was "essentially cut in half," Dr Cohen reported.

The multivariate analysis was necessary because the patients who were not prescribed statins were, among other differentiators, significantly younger than nonusers (51.9 vs 60.7 years; P< .01) and less obese (28.1 vs 29.2kg/mm2; P< .01).

Notably, on follow-up, average levels of low-density-lipoprotein cholesterol and total cholesterol were significantly lower in statin users than in nonusers, suggesting compliance with medications.

Dr Cohen stressed this finding because the earlier research on this subject lacked this analysis of lab values. This supplementary lab data added a "high degree of credibility" to our study findings, he said.

The study also confirmed other risk factors for stone development, such as being overweight, being black, being older, having osteoporosis, and having a thiazide prescription, he noted.

When the researchers looked at the relation between lipids in the blood and the risk for future kidney stones, only elevated triglyceride levels were found to be a risk factor for the development of a stone in nonusers of statins, he reported. "There was no association between elevated LDL or total cholesterol and nephrolithiasis."

The study had some limitations. When patients learned they had hyperlipidemia, they might have changed their diet or lifestyle. Plus, high cholesterol levels were often "borderline," not extremely high, Dr Cohen explained. Therefore, these results might not apply to patients with very high levels.

But the study's conclusion — that statins have a protective effect against the formation of kidney stones in adults with hyperlipidemia — will have to remain an academic matter for now, said Timothy Avench, MD, a urologist at the University of Pittsburgh, who moderated the press conference.

The results, even when combined with those from the 2013 study, are not enough to prompt a prophylactic use of statins. "It will take a lot of force to make this show up in practice," he said.

Dr Cohen has disclosed no relevant financial relationships. Dr Avench reports a financial relationship with Bard Medical.

American Urological Association (AUA) 2016 Annual Meeting: AbstractPD31-10. Presented May8, 2016.

Follow Medscape senior journalist Nick Mulcahy on Twitter: @MulcahyNick

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