Demographics and characterization of 10,282 Randall plaque-related kidney stones: a new epidemic?
Demographics and characterization of 10,282 Randall plaque-related kidney stones: a new epidemic?
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DOI：
10.1097/md.0000000000000566
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发表时间：
2015-03
期刊：
影响因子：
1.6
通讯作者：
Daudon M
中科院分区：
文献类型：
--
作者：
Letavernier E;Vandermeersch S;Traxer O;Tligui M;Baud L;Ronco P;Haymann JP;Daudon M
补充数字内容可在文本中获得肾结石的发病率在工业化国家逐步增加，但兰德尔斑块在这种流行病中的意义仍然未知。我们的目的是确定兰德尔斑块相关结石的患病率是否增加，在过去的几十年中，分析了30,149个完整的结石，主要含有草酸钙自1989年以来（横断面研究），并确定与兰德尔斑块相关结石患者的决定因素（病例对照研究）。兰德尔斑块相关结石的比例在3个时间段进行了评估：1989-1991年，1999-2001年和2009-2011年。此外，我们分析了105例草酸钙结石患者的临床和生化参数，有或无斑块。在30，149例草酸钙结石中，10，282例（34.1%）含有Randall斑块残留物。兰德尔斑块相关结石的患病率在过去几年中急剧增加。1989-1991年，年轻女性草酸钙结石中17%与Randall斑块有关，20年后这一比例上升至59%（P <0.001）。 与无斑块患者相比，有斑块患者在生命中较早经历首次结石相关事件（中位年龄26岁vs 34岁，P = 0.02），血清离子钙水平升高（P = 0.04），血清骨钙素升高（P = 0.001），但25-羟基维生素D水平相似。 Logistic回归分析显示年龄（OR 0.96，CI 0.926-0.994，P = 0.02）、体重（OR 0.97，CI 0.934-0.997，P = 0.03）和血清骨钙素水平（OR 1.12，CI 1.020-1.234，P = 0.02）与Randall斑块独立相关。 FokI f维生素D受体多态性在斑块患者中的患病率更高（P = 0.047）。 总之，这些研究结果表明，兰德尔斑块相关的肾结石在年轻患者中流行，并提出了改变维生素D反应的可能含义。
Supplemental Digital Content is available in the text Renal stone incidence has progressively increased in industrialized countries, but the implication of Randall plaque in this epidemic remains unknown. Our objectives were to determine whether the prevalence of Randall plaque-related stones increased during the past decades after having analyzed 30,149 intact stones containing mainly calcium oxalate since 1989 (cross-sectional study), and to identify determinants associated with Randall plaque-related stones in patients (case–control study). The proportion of Randall plaque-related stones was assessed over 3 time periods: 1989–1991, 1999–2001, and 2009–2011. Moreover, we analyzed clinical and biochemical parameters of 105 patients affected by calcium oxalate stones, with or without plaque. Of 30,149 calcium oxalate stones, 10,282 harbored Randall plaque residues (34.1%). The prevalence of Randall plaque-related stones increased dramatically during the past years. In young women, 17% of calcium oxalate stones were associated with Randall plaque during the 1989–1991 period, but the proportion rose to 59% 20 years later (P < 0.001). Patients with plaques experienced their first stone-related event earlier in life as compared with those without plaque (median age 26 vs 34 years, P = 0.02), had increased ionized serum calcium levels (P = 0.04), and increased serum osteocalcin (P = 0.001) but similar 25-hydroxyvitamin D levels. The logistic regression analysis showed that age (odds ratio [OR] 0.96, confidence interval [CI] 0.926–0.994, P = 0.02), weight (OR 0.97, CI 0.934–0.997, P = 0.03), and osteocalcin serum levels (OR 1.12, CI 1.020–1.234, P = 0.02) were independently associated with Randall plaque. The prevalence of the FokI f vitamin D receptor polymorphism was higher in patients with plaque (P = 0.047). In conclusion, these findings point to an epidemic of Randall plaque-associated renal stones in young patients, and suggest a possible implication of altered vitamin D response.