Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of followup
Diabetes mellitus and hypertension associated with shock wave lithotripsy of renal and proximal ureteral stones at 19 years of followup
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DOI：
10.1016/s0022-5347(05)00989-4
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发表时间：
2006-05-01
影响因子：
6.6
通讯作者：
Segura, JW
中科院分区：
文献类型：
--
作者：
Krambeck, AE;Gettman, MT;Segura, JW
目的：SWL 彻底改变了肾结石的治疗方法，是无并发症的肾脏和近端输尿管结石的首选治疗方法。自 1982 年推出以来，关于早期不良反应的相互矛盾的报告已经发表。然而，据我们所知，与 SWL 相关的长期医疗影响尚不清楚。我们评估了与 SWL 对肾脏和近端输尿管结石相关的不良医疗影响。材料和方法：图表审查确定了 1985 年在我们机构接受 SWL 治疗的 630 名患者。向 2004 年仍活着的 578 名患者发送了调查问卷。应答率为 58.9%。根据年龄、性别和就诊年份将受访者与接受非手术治疗的肾结石患者队列进行匹配。结果：在 19 年的随访中，SWL 组高血压更为常见（OR 1.47，95% Cl 1.03、2.10，p = 0.034）。高血压的发生与双侧治疗相关（p = 0.033）。在 SWL 组中，16.8% 的患者患有糖尿病。接受 SWL 治疗的患者比对照组更容易患糖尿病（OR 3.23，95% CI 1.73 至 6.02，p < 0.001）。控制体重指数变化的多变量分析显示，SWL 组存在持续的糖尿病风险（OR 3.75，95% Cl 1.56 至 9.02，p = 0.003）。糖尿病与电击次数和治疗强度有关（p = 0.005 和 0.007） 结论：在 19 年的随访中，肾和近端输尿管结石的 SWL 与高血压和糖尿病的发生有关。这些病症的发生率明显高于接受保守治疗的肾结石患者队列。
Purpose: SWL has revolutionized the management of nephrolithiasis and it is a preferred treatment for uncomplicated renal and proximal ureteral calculi. Since its introduction in 1982, conflicting reports of early adverse effects have been published. However, to our knowledge the long-term medical effects associated with SWL are unknown. We evaluated these adverse medical effects associated with SWL for renal and proximal ureteral stones.Materials and Methods: Chart review identified 630 patients treated with SWL at our institution in 1985. Questionnaires were sent to 578 patients who were alive in 2004. The response rate was 58.9%. Respondents were matched by age, sex and year of presentation to a cohort of patients with nephrolithiasis who were treated nonsurgically.Results: At 19 years of followup hypertension was more prevalent in the SWL group (OR 1.47, 95% Cl 1.03, 2.10, p = 0.034). The development of hypertension was related to bilateral treatment (p = 0.033). In the SWL group diabetes mellitus developed in 16.8% of patients. Patients treated with SWL were more likely to have diabetes mellitus than controls (OR 3.23, 95% CI 1.73 to 6.02, p < 0.001). Multivariate analysis controlling for change in body mass index showed a persistent risk of diabetes mellitus in the SWL group (OR 3.75, 95% Cl 1.56 to 9.02, p = 0.003). Diabetes mellitus was related to the number of administered shocks and treatment intensity (p = 0.005 and 0.007)Conclusions: At 19 years of followup SWL for renal and proximal ureteral stones was associated with the development of hypertension and diabetes mellitus. The incidence of these conditions was significantly higher than in a cohort of conservatively treated patients with nephrolithiasis.