Lithogenic risk factors in the morbidly obese population
Lithogenic risk factors in the morbidly obese population
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DOI：
10.1016/j.juro.2007.11.072
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发表时间：
2008-04-01
影响因子：
6.6
通讯作者：
Monga, Manoj
中科院分区：
文献类型：
--
作者：
Duffey, Branden G.;Pedro, Renato N.;Monga, Manoj
目的：据我们所知，病态肥胖人群的基线致石危险因素目前尚不清楚。先前的研究评估了已知的结石形成者，并将风险与体重指数增加相关联。我们描述的危险因素，尿结石形成在一组肥胖的patients.Materials和方法：病人安排胃旁路手术前提供了24小时的尿液收集。记录患者人口统计学资料、药物和补充剂消耗。将饮食摄入日记转换为每日kcal、Ca、Na和蛋白质消耗量。根据性别、糖尿病或肾结石病史、利尿剂使用和钙补充评估组间差异。结果：共45例患者提供了样本进行分析。平均+/- SD体重指数为49.5 +/- 9.1 k g/m2，平均年龄为47.0 +/- 10.5岁。总体而言，97.8%的患者至少确定了1个致石风险因素。低尿量是最常见的异常，影响71.1%的患者。男性患者排出的Ox（p = 0.0014）、Na（p = 0.020）、PO 4（P = 0.0083）和SO 4（P = 0.0014）显著高于女性。与非结石患者相比，有肾结石病史的患者排出的草酸盐显著更多（p = 0.018），相对尿酸钠过饱和度更高（p = 0.00093）。使用氢氯噻嗪与尿酸钠相对过饱和度显著增加相关（p = 0.0097）。体重指数的增加与镁（r =-0.38，p = 0.01）和透钙磷石（r =-0.30，p0.04）呈负相关。结论：在我们的病态肥胖患者队列中，98%的患者在24小时尿液收集中至少有I个致石危险因素。这项研究确定了高泌尿系统结石的风险，在病态肥胖，并提出了可能的途径，饮食和/或药物预防措施。未来的研究将确定减肥手术如何改变这些风险因素。
Purpose: To our knowledge baseline lithogenic risk factors in the morbidly obese population are currently unknown. Prior studies evaluated known stone formers and correlated risk with increasing body mass index. We describe risk factors for urinary stone formation in a group of unselected morbidly obese patients.Materials and Methods: Patients scheduled for gastric bypass provided a 24-hour urine collection before surgery. Patient demographics, medications and supplement consumption were recorded. A dietary intake diary was converted into daily kcal, Ca, Na and protein consumption. Differences between groups based on gender, history of diabetes or nephrolithiasis, diuretic use and Ca supplementation were evaluated. Correlation of stone risk parameters with body mass index was evaluated.Results: A total of 45 patients provided samples for analysis. Mean +/- SD body mass index was 49.5 +/- 9.1 k g/m(2) and mean age was 47.0 +/- 10.5 years. Overall 97.8% of patients had at least 1 lithogenic risk factor identified. Low urinary volume was the most common abnormality, affecting 71.1% of patients. Male patients excreted significantly more Ox (p = 0.0014), Na (p = 0.020), PO4 (P = 0.0083) and SO4 (P = 0.0014) than females. Patients with a history of nephrolithiasis excreted significantly more oxalate (p = 0.018) and had higher relative Na urate supersaturation (p = 0.00093) than nonstone formers. Hydrochlorothiazide use was associated with significantly increased Na urate relative supersaturation (p = 0.0097). Increasing body mass index was inversely associated with Mg (r = -0.38, p = 0.01) and brushite (r = -0.30, p 0.04).Conclusions: Of our cohort of morbidly obese patients 98% had at least I lithogenic risk factor identified on 24-hour urine collection. This study identified a high urinary stone risk in the morbidly obese and suggests possible avenues for dietary and/or pharmacological preventive measures. Future studies will determine how bariatric surgery alters these risk factors.