Type 2 diabetes increases the risk for uric acid stones
Type 2 diabetes increases the risk for uric acid stones
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DOI：
10.1681/asn.2006030262
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发表时间：
2006-07-01
影响因子：
13.6
通讯作者：
Jungers, P
中科院分区：
文献类型：
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作者：
Daudon, M;Traxer, O;Jungers, P
据报道，糖尿病患者肾结石的患病率增加。由于胰岛素抵抗是代谢综合征和2型糖尿病的特征，通过肾氨生成受损导致尿液pH值降低，并且由于尿液pH值低是尿酸（UA）结石形成的主要因素，因此假设2型糖尿病应有利于UA结石的形成。因此，分析了272例（11%）2型糖尿病患者和2192例非2型糖尿病患者的2464例结石中主要结石成分的分布。合并2型糖尿病患者UA结石的比例为35.7%，而非2型糖尿病患者UA结石的比例为11.3%（P < 0.0001）。相反，UA患者中2型糖尿病患者的比例显著高于钙结石患者（27.8%对6.9%; P < 0.0001）。逐步回归分析确定2型糖尿病是与UA结石风险独立相关的最强因素（优势比6.9; 95%置信区间5.5 - 8.8）。2型糖尿病的适当影响在女性和年龄和体重指数最低的患者中最为明显。总之，鉴于2型糖尿病和UA结石形成之间的强相关性，建议UA肾结石可能与胰岛素抵抗相关。因此，建议UA结石患者，特别是超重患者，应筛查是否存在2型糖尿病或代谢综合征。
An increased prevalence of nephrolithiasis has been reported in patients with diabetes. Because insulin resistance, characteristic of the metabolic syndrome and type 2 diabetes, results in lower urine pH through impaired kidney ammoniagenesis and because a low urine pH is the main factor of uric acid (UA) stone formation, it was hypothesized that type 2 diabetes should favor the formation of UA stones. Therefore, the distribution of the main stone components was analyzed in a series of 2464 calculi from 272 (11%) patients with type 2 diabetes and 2192 without type 2 diabetes. The proportion of UA stones was 35.7% in patients with type 2 diabetes and 11.3% in patients without type 2 diabetes (P < 0.0001). Reciprocally, the proportion of patients with type 2 diabetes was significantly higher among UA than among calcium stone formers (27.8 versus 6.9%; P < 0.0001). Stepwise regression analysis identified type 2 diabetes as the strongest factor that was independently associated with the risk for UA stones (odds ratio 6.9; 95% confidence interval 5.5 to 8.8). The proper influence of type 2 diabetes was the most apparent in women and in patients in the lowest age and body mass index classes. In conclusion, in view of the strong association between type 2 diabetes and UA stone formation, it is proposed that UA nephrolithiasis may be added to the conditions that potentially are associated with insulin resistance. Accordingly, it is suggested that patients with UA stones, especially if overweight, should be screened for the presence of type 2 diabetes or components of the metabolic syndrome.