Relationship between nephrolithiasis and dyslipidemia in primary gout patients

中华风湿病学杂志 Pub Date : 2018-04-15 DOI:10.3760/CMA.J.ISSN.1007-7480.2018.04.003

Yu Wang, X. Deng, Zhuoli Zhang

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Abstract

Objective To explore the impact of dyslipidemia on uric acid stones by analyzing the relationship between blood lipids and urolithiasis in primary gouty patients. Methods We retrospectively identified patients with nephrolithiasis in primary gout patients who underwent stone chemical analysis, compared with gout patients without nephrolithiasis. The clinical parameters, urine analysis and lipid levels were analyzed. Patients were divided into groups based on serum lipid levels. The groups were compared based on demographic data and stone composition. Correlations were analyzed between serum lipid, urinary pH and uric acid stones. Moreover, the risk factors of uric acid stones were determined by logistic regression analysis. Analysis of variance, t-test, chi-square test, Spearman′s test and Logistic regression were used for statistical analysis. Results ① A total of 144 gout patients were included in study, 48 patients with urolithiasis and 96 patients without urolithiasis. ② Serum lipid levels were significantly lower in urolithiasis group than those patients without urolithiasis including triglyceride (TG) [1.6(0.9, 2.1) mmol/L vs 2.2(1.4, 3.2) mmol/L, Z=2.38, P=0.01], total cholesterol (TC) [(4.4±1.2) mmol/L vs (5.1±1.0) mmol/L, t=5.3, P=0.006]; low density lipoprotein cholesterol(LDL-C) [(2.5±0.9) mmol/L vs (3.2±0.9) mmol/L, t=4.2, P=0.005]. ③ Compared to oxalate stone formers, uric acid stone formers had significantly higher TG [(1.8±0.6) mmol/L vs (0.9±0.5) mmol/L, t=4.9, P=0.001), TC [(4.4±1.1) mmol/L vs (3.8±1.0) mmol/L, t=1.8, P=0.001] and LDL-C [(2.8±0.9) mmol/L vs (2.0±0.7) mmol/L, t=3.5, P=0.045], while the high density lipoprotein (HDL) level was lower [(0.94±0.23) mmol/L vs (1.32±0.41) mmol/L, t=-4.0, P=0.002]. ④ Percentage of uric acid stones in high TG group was higher than normal TG group [85% (17/20 vs 46.4% (13/28) , χ2=7.4, P=0.007], in addition, the percentage of uric acid stones in low HDL group was higher than normal HDL group [(82.1% (23/28) vs 35.0% (7/20) , χ2=11.1, P=0.001]. ⑤ Uric acid stones were significantly correlated with high TG, low LDL and urinary pH(r=0.522, 0.47, -0.212, respectively). Logistic analysis showed risk factors for uric acid stone in primary gouty patients were high TG [OR=2.38, 95%CI(1.41, 13.7); P=0.01] and lower HDL level [OR=0.01, 95%CI(0.01, 0.43); P=0.01]. Conclusion There is a link between dyslipidemia and kidney uric acid stone risk in primary gout patients. Specific alterations in patient′s lipid profile may portend unique aberrations in urine physico-chemistry and uric acid stone risk. Key words: Gout; Kidney; Nephrolithiasis; Dyslipidemia; Body mass index

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原发性痛风患者肾结石与血脂异常的关系

目的通过分析原发性痛风患者血脂与尿石症的关系，探讨血脂异常对尿酸结石的影响。方法回顾性分析原发性痛风患者中有肾结石的患者，并与无肾结石的痛风患者进行比较。分析两组患者的临床参数、尿液分析及血脂水平。根据血脂水平将患者分为两组。根据人口统计数据和石头组成对各组进行比较。分析血脂、尿pH值与尿酸结石的相关性。此外，通过logistic回归分析确定尿酸结石的危险因素。采用方差分析、t检验、卡方检验、Spearman检验和Logistic回归进行统计分析。结果①共纳入144例痛风患者，其中合并尿石症患者48例，非尿石症患者96例。②尿石症组血脂水平明显低于非尿石症组，甘油三酯(TG) [1.6(0.9, 2.1) mmol/L vs 2.2(1.4, 3.2) mmol/L, Z=2.38, P=0.01]、总胆固醇(TC)[(4.4±1.2)mmol/L vs(5.1±1.0)mmol/L, t=5.3, P=0.006];低密度脂蛋白胆固醇(LDL-C)[(2.5±0.9)mmol/L vs(3.2±0.9)mmol/L, t=4.2, P=0.005]。③与草酸类结石患者相比，尿酸类结石患者TG[(1.8±0.6)mmol/L vs(0.9±0.5)mmol/L, t=4.9, P=0.001]、TC[(4.4±1.1)mmol/L vs(3.8±1.0)mmol/L, t=1.8, P=0.001]、LDL-C[(2.8±0.9)mmol/L vs(2.0±0.7)mmol/L, t=3.5, P=0.045]显著增高，高密度脂蛋白(HDL)水平较低[(0.94±0.23)mmol/L vs(1.32±0.41)mmol/L, t=-4.0, P=0.002]。④高TG组尿酸结石发生率高于正常TG组[85% (17/20)vs 46.4% (13/28)， χ2=7.4, P=0.007]，低HDL组尿酸结石发生率高于正常HDL组[82.1% (23/28)vs 35.0% (7/20)， χ2=11.1, P=0.001]。⑤尿酸结石与高TG、低LDL、尿pH呈显著相关(r分别为0.522、0.47、-0.212)。Logistic分析显示，原发性痛风患者尿酸结石的危险因素为高TG [OR=2.38, 95%CI(1.41, 13.7);P=0.01]和较低的HDL水平[OR=0.01, 95%CI(0.01, 0.43);P = 0.01)。结论原发性痛风患者血脂异常与肾尿酸结石风险有一定关系。患者脂质谱的特殊改变可能预示着尿液物理化学和尿酸结石风险的独特异常。关键词:痛风;肾脏;肾结石;血脂异常;身体质量指数

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来源期刊

中华风湿病学杂志

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发文量

5947

期刊介绍： CHINESE JOURNAL OF RHEUMATOLOGY is a professional academic journal of rheumatology published by the Chinese Association for Science and Technology and sponsored by the Chinese Medical Association at home and abroad, which was founded in November 1997 and published monthly on the 15th of each month. ISSN 1007-7480 and 14-1217/R in China. CHINESE JOURNAL OF RHEUMATOLOGY reports on the leading scientific research results and clinical diagnosis and treatment experiences in the field of rheumatology, as well as the basic theoretical researches that have a guiding effect on the clinical practice of rheumatology and are closely integrated with the clinical practice of rheumatology, using the general practitioners of rheumatology as the main target readers. Columns include: monographs, treatises, clinical research (clinical case review), basic research, short treatises, expert consensus, case reports, reviews, lectures, conference (symposium) proceedings, continuing education, academic dynamics, academic controversy and other columns (of which clinical research (clinical case review), basic research, short treatises are regarded as treatises). Index: The journal has been accepted by the American Chemical Abstracts (CA) ‘China's scientific and technological paper statistics source journal (China's scientific and technological core journals)’ ‘Chinese core journals list’ ‘China Science Citation Database’ ‘China Academic Journals Comprehensive Evaluation Database’ ‘China Academic Journals Comprehensive Evaluation Database’. Comprehensive Evaluation Database of Academic Journals’ “Japan Science and Technology Agency Database”, Peking University Core Journals (2008 edition, 2011 edition, 2014 edition, 2017 edition), China Science Citation Database (2011-2012, 2013-2014, 2015-2016, 2017-2018, 2019-2020) and other databases.