Diabetes mellitus and the risk of nephrolithiasis
Diabetes mellitus and the risk of nephrolithiasis
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DOI：
10.1111/j.1523-1755.2005.00516.x
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发表时间：
2005-09-01
影响因子：
19.6
通讯作者：
Curhan, GC
中科院分区：
文献类型：
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作者：
Taylor, EN;Stampfer, MJ;Curhan, GC
背景胰岛素抵抗是2型糖尿病（DM）的主要特征，并可能增加肾结石形成的风险。现有的关于糖尿病与肾结石之间关系的横断面数据是有限的，迄今为止还没有前瞻性研究评估糖尿病与肾结石风险之间的关系。为了评估糖尿病和肾结石之间的关系，我们进行了一项包括20多万名参与者的3大队列的横断面研究：护士健康研究I（老年女性），护士健康研究II（年轻女性）和健康专业人员随访研究（男性）。然后，我们前瞻性地研究了糖尿病和肾结石之间的关系，随访时间超过44年。由于胰岛素抵抗可以在糖尿病诊断之前几十年，我们也前瞻性地研究了肾结石和糖尿病诊断之间的关系。校正年龄、体重指数、噻嗪类利尿剂使用、液体摄入和饮食因素的多变量回归模型。在基线时，糖尿病患者与非糖尿病患者相比，老年女性中结石患病的多变量相对风险为1.38（95%CI 1.06-1.79），年轻女性为1.67（95%CI 1.28-2.20），男性为1.31（95%CI 1.11-1.54）。糖尿病患者与非糖尿病患者相比，发生肾结石的多变量相对风险在老年女性中为1.29（95% CI 1.05-1.58），在年轻女性中为1.60（95% CI 1.16-2.21），在男性中为0.81（95% CI 0.59-1.09）。与无肾结石史的参与者相比，老年女性中有肾结石史的参与者发生糖尿病的多变量相对风险为1.33（95%CI 1.18-1.50），年轻女性为1.48（95%CI 1.14-1.91），男性为1.49（95%CI 1.29-1.72）。糖尿病是发生肾结石的危险因素。需要进一步的研究来确定结石形成者糖尿病风险的增加是否是由于亚临床胰岛素抵抗。
Background. Insulin resistance is a central feature of type 2 diabetes mellitus (DM) and may increase the risk of kidney stone formation. Existing cross-sectional data on the association between DM and nephrolithiasis are limited, and no prospective study to date has evaluated the relation between DM and the risk of kidney stones.Methods. To evaluate the relation between DM and prevalent kidney stones, we conducted a cross-sectional study of 3 large cohorts including over 200,000 participants: the Nurses' Health Study I (older women), the Nurses' Health Study II (younger women), and the Health Professionals Follow-up Study (men). We then prospectively studied the association between DM and incident nephrolithiasis over a combined 44 years of follow-up. Because insulin resistance can precede the diagnosis of DM by decades, we also prospectively examined the relation between kidney stones and the diagnosis of incident DM. Multivariate regression models adjusted for age, body mass index, thiazide diuretic use, fluid intake, and dietary factors.Results. At baseline, the multivariate relative risk of prevalent stone disease in individuals with DM compared to individuals without was 1.38 (95% CI 1.06-1.79) in older women, 1.67 (95% CI 1.28-2.20) in younger women, and 1.31 (95% CI 1.11-1.54) in men. Prospectively, the multivariate relative risk of incident kidney stone formation in participants with DM compared to participants without was 1.29 (95% CI 1.05-1.58) in older women, 1.60 (95% CI 1.16-2.21) in younger women, and 0.81 (95% CI 0.59-1.09) in men. The multivariate relative risk of incident DM in participants with a history of kidney stones compared to participants without was 1.33 (95% CI 1.18-1.50) in older women, 1.48 (95% CI 1.14-1.91) in younger women, and 1.49 (95% CI 1.29-1.72) in men.Conclusion. DM is a risk factor for the development of kidney stones. Additional studies are needed to determine if the increased risk of DM in stone formers is due to subclinical insulin resistance.