尿酸结石与血脂异常的相关性研究及危险因素分析

目的探讨尿酸结石与血脂异常的相关性,分析尿酸结石的致病危险因素。方法回顾性分析苏州大学附属常熟医院2014年1月至2019年10月收治的尿石症患者的病例资料。93例经结石成分分析确诊为尿酸结石患者为尿酸结石组,男77例(82.8%),女16例(17.2%),中位年龄64岁。按性别、年龄等条件匹配选取同时期的草酸钙结石患者321例为草酸钙结石组,男264例(82.2%),女57例(17.8%),平均年龄61岁。选取我院体检的正常非结石人群306例为对照组,男252例(82.4%),女54例(17.6%),平均年龄61岁。3组的年龄和性别比方面差异无统计学意义(P>0.05)。尿酸结石组、草酸钙结石组、对照组体质指数(BMI)分别为(26.21±2.97)、(24.48±1.87)、(23.75±1.36)kg/m2,差异有统计学意义(P<0.01)。记录3组的血尿酸、尿pH值,以及血脂指标:甘油三酯(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C),分析上述指标与结石成分的相关性。将尿酸结石组按照有无高尿酸血症(HUA)分为伴HUA组41例和不伴HUA组52例,并选择对照组内伴HUA的人群共66例(单纯HUA组),比较上述3组的血脂异常情况及尿pH值。采用多因素logistic回归分析尿酸结石形成的独立危险因素。结果尿酸结石组与草酸钙结石组的TG[1.52(1.02,2.78)mmol/L与1.10(0.80,1.76)mmol/L,P=0.001]、高TG血症患病率[31.2%(29/93)与14.0%(45/321),P<0.01]、低HDL-C血症患病率[28.0%(26/93)与40.2%(129/321),P=0.048]、高LDL-C血症患病率[51.6%(48/93)与36.5%(117/321),P=0.031]、血尿酸水平[(422.28±114.15)mmol/L与(335.72±83.32)mmol/L,P<0.01]及尿pH值[5.5(5.0,6.0)与6.0(6.0,6.5),P<0.01]差异有统计学意义。尿酸结石组与对照组的TG[1.52(1.02,2.78)mmol/L与(1.37±0.55)mmol/L,P=0.010]、高TG血症患病率[31.2%(29/93)与4.9%(15/306),P<0.01]、HDL-C水平[1.13(0.96,1.44)mmol/L与(1.42±0.31)mmol/L,P<0.01]、低HDL-C血症患病率[28.0%(26/93)与3.9%(12/306),P<0.01]、血尿酸[(422.28±114.15)mmol/L与(354.33±79.68)mmol/L,P<0.01]及尿pH值[5.5(5.0,6.0)与6.0(5.5,6.0),P<0.01]差异有统计学意义。尿酸结石伴HUA组和不伴HUA组间尿pH值[5.5(5.0,6.0)与6.0(5.5,6.0),P=0.014]差异有统计学意义。尿酸结石伴HUA组与单纯HUA组的高TG血症患病率[31.7%(13/41)与9.1%(6/66),P=0.003]、低HDL-C血症患病率[29.3%(12/41)与13.6%(9/66),P=0.048]差异有统计学意义。多因素logistic回归分析结果显示,肥胖(OR=1.68,P<0.01)、高TG血症(OR=7.37,P=0.002)、低HDL-C血症(OR=10.46,P=0.001)及低尿pH值(OR=0.10,P<0.01)为尿酸结石致病的独立危险因素。结论尿酸结石患者多有血脂代谢异常,肥胖、高TG血症、低HDL-C血症及低尿pH值与尿酸结石的发生密切相关。

The relationship between uric acid urolithiasis and dyslipidemia

Objective To evaluate the relationship between dyslipidemia and uric acid urolithiasis,and explore the risk factors of uric acid urolithiasis.Methods 93 patients with uric acid urolithiasis identified by stone composition analysis were retrospective analyzed from January 2014 to October 2019 were classified as uric acid urolithiasis group.Among them there were 77 men accounting for 82.8%,16 women accounting for 17.2%,the median age is 64 years old.According to sex,age and other conditions,321 patients with calcium oxalate urolithiasis in the same period were selected as calcium oxalate stone group.Among them there were 264 men accounting for 82.2%,57 women accounting for 17.8%,the average age is 64 years old.While 306 non-stone people examined in hospital as control group in the same period who matched with age and gender.Among them there were 252 men accounting for 82.4%,54 women accounting for 17.6%,the average age is 61 years old.There was no significant difference in age and sex ratio among the three groups.The body mass index(BMI)of uric acid urolithiasis group,calcium oxalate urolithiasis group and control group were significantly different(P<0.01).Serum uric acid,urine pH and blood lipids:triglyceride(TG),cholesterol(TC),high density lipoprotein(HDL-C)and low density lipoprotein(LDL-C)were recorded in the three groups,and the correlation between the above indexes and stone composition was analyzed.The uric acid urolithiasis group was divided into hyperuricemia(HUA)group(n=41)and Non HUA group(n=52)according to serum uric acid,and 66 cases with HUA were selected in the control group.The dyslipidemia and urine pH levels of the above three groups were compared.The multivariate Logistic regression analysis was used to identify the independent risk factors associated with uric acid urolithiasis formation.Results There were significant differences in TG level,incidence of hypertrigly-ceridemia,low HDL-cholesterolemia,high LDL-cholesterolemia,serum uric acid and urine pH between uric acid urolithiasis group and calcium oxalate urolithiasis group(P<0.05).Significant differences were seen in TG level,HDL-C level,incidence of hypertriglyceridemia and low HDL-cholesterolemia,serum uric acid and urine pH between uric acid urolithiasis group and control group.There was significant difference in urine pH between uric acid urolithiasis with and Non HUA group.Significant difference in the incidence of hypertriglyceridemia and low HDL-cholesterolemia were seen between uric acid urolithiasis with HUA group and HUA group.Multivariate Logistic regression analysis showed that obesity(odds ratio=1.68,P<0.001),hypertriglyceridemia(odds ratio=7.37,P=0.002),low HDL-cholesterolemia(odds ratio=10.46,P=0.001)and low urinary pH(odds ratio=0.10,P<0.001)were independent risk factors for uric acid urolithiasis.Conclusions Dyslipidemia was more likely associated with uric acid urolithiasis.Obesity,hypertriglyceridemia,low HDL-cholesterolemia and low urinary pH are closely related to the occurrence of uric acid urolithiasis.