Oxalobacter formigenes may reduce the risk of calcium oxalate kidney stones
Oxalobacter formigenes may reduce the risk of calcium oxalate kidney stones
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DOI：
10.1681/asn.2007101058
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发表时间：
2008-06-01
影响因子：
13.6
通讯作者：
Cave, David R.
中科院分区：
文献类型：
--
作者：
Kaufman, David W.;Kelly, Judith P.;Cave, David R.
大多数肾结石主要由草酸钙组成。产甲酸草酸杆菌是一种革兰氏阴性厌氧细菌，在肠道中代谢草酸盐，并存在于大部分正常成年人群中。假设O.产甲酸菌可导致结肠对草酸盐的吸收增加，随后尿中草酸盐的增加可促进结石的形成。为了验证这一假设，进行了一项病例对照研究，包括247例复发性草酸钙结石的成人患者和259例年龄、性别和地区匹配的对照组。O.通过粪便培养确定的产甲酸菌在病例患者中为17%，在对照组中为38%;基于控制人口统计学因素、饮食草酸盐和抗生素使用的多变量分析，定植的优势比为0.3（95%置信区间为0.2 - 0.5）。在年龄、性别、种族/民族、地区和抗生素使用分层中始终存在负相关。在完成24小时尿液收集的参与者中，肾结石的风险与尿草酸盐成正比，但当尿因素包括在多变量模型中时，O.甲酸杆菌保持0.3（95%置信区间0.1至0.7）。令人惊讶的是，中位尿草酸排泄量与有无O无差异。产甲酸菌定殖这些结果表明，O.甲酸根与复发性草酸钙结石形成者的风险降低70%相关。
Most kidney stones are composed primarily of calcium oxalate. Oxalobacter formigenes is a Gram-negative, anaerobic bacterium that metabolizes oxalate in the intestinal tract and is present in a large proportion of the normal adult population. It was hypothesized that the absence of O. formigenes could lead to increased colonic absorption of oxalate, and the subsequent increase in urinary oxalate could favor the development of stones. To test this hypothesis, a case-control study involving 247 adult patients with recurrent calcium oxalate stones and 259 age-, gender-, and region-matched control subjects was performed. The prevalence of O. formigenes, determined by stool culture, was 17% among case patients and 38% among control subjects; on the basis of multivariate analysis controlling demographic factors, dietary oxalate, and antibiotic use, the odds ratio for colonization was 0.3 (95% confidence interval 0.2 to 0.5). The inverse association was consistently present within strata of age, gender, race/ethnicity, region, and antibiotic use. Among the subset of participants who completed a 24-h urine collection, the risk for kidney stones was directly proportional to urinary oxalate, but when urinary factors were included in the multivariable model, the odds ratio for O. formigenes remained 0.3 (95% confidence interval 0.1 to 0.7). Surprisingly, median urinary oxalate excretion did not differ with the presence or absence of O. formigenes colonization. In conclusion, these results suggest that colonization with O. formigenes is associated with a 70% reduction in the risk for being a recurrent calcium oxalate stone former.