血清中膽固醇與腎含鈣結石病患者的動脈粥樣硬化和體循環中氧化壓力相關
黃鶴翔、1廖寶祺
國立成功大學附設醫院泌尿科、1國立成功大學工業衛生科暨環境醫學研究所
Serum cholesterol level is associated with atherosclerosis and circular oxidative stress in patients with calcium-containing kidney stone disease
Ho-Shiang Huang, 1 Pao-Chi Liao
Department of Urology, National Cheng Kung University, Tainan, Taiwan; 1 Industrial Health Branch and Environmental Medicine Institute, National Cheng Kung University, Tainan, Taiwan.
Purpose: We studied the association between hypercholesteremia and 24-hour urinalysis in patients with urinary CaOx and CaP stone disease, respectively. Serum makers that associated with urinary stone formations: acute inflammatory markers, adhesion molecule, oxidative and nitrosative stress, and chemokines were also examined.
Materials and Methods: There are 114 patients with kidney stone disease and 33 controls (no urolithiasis) in this prospective study. Stone composition was examined in each patient and 24-hour urine sample and serum sample were collected one month after stone surgery. Patients with CaOx >50% stone (or CaP >50% stone) were divided into groups based on total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), respectively. Each group was compared based on demographic data, each component of 24-hour urinalysis, and CaOx (CaP) supersaturation index. Serum levels of 8-OHdG, NT, IL-6, VCAM1, and NGAL were also evaluated in each high cholesterol group. Atherosclerosis score was measured by ultrasonographic scan of the extracranial carotid arteries and scored from 0 (IMT<0.8mm, no plaque) to 5 (occlusion). Multivariate analysis was used to evaluate the possible significant factors that might be associated with urinary stone formation in patients with high serum cholesterol levels.
Results: On multivariate analysis, high serum TC level was associated with lower urinary citrate (OR, 0.98, 95% CI, 0.96-0.99, P = 0.003) and higher atherosclerosis grade (AG; OR, 3.79, 95% CI, 1.22-11.72, P = 0.021) in CaOx group; as well as associated with urinary citrate, abdomen circumflex and AG in CaP group. High serum LDL level was associated with urinary citrate, oxalate and AG in both CaOx and CaP group. Among the examined serum markers, high serum TC and high serum LDL were associated with increased serum 8-OHdG level in both CaOx (OR, 1.49, 95% CI, 1.04-2.15 for TC; OR, 1.50, 95% CI, 1.09-2.06 for LDL) and CaP groups (OR, 1.48, 95% CI, 1.04-2.13 for TC; OR, 1.61, 95% CI, 1.16-2.21 for LDL).
Conclusion: Our prospective study found a link among hypercholestermia, atherosclerosis, and kidney stone disease. Lower urinary citrate is associated with calcium-containing stone disease when high serum TC or high LDL presented; whereas high urinary oxalate is associated in stone patients when serum LDL is high. Atherosclerosis may cause excessive oxidative stress in the circulation in patients with higher serum TC or LDL levels.