使用「結構方程模式」分析產生尿酸結石的因子與途徑
陳妤甄1,2、陳浩瑋1,2、吳文正1,2、周以和1,2
高雄醫學大學 醫學院 臨床醫學研究所1
高雄醫學大學附設醫院 泌尿部2
Using the novel “structural equation modeling” to analyze factors and pathways on the development of uric acid nephrolithiasis
Yu-Chen Chen1,2, Hao-Wei Chen1,2, Wen-Jeng Wu1,2, Yii-Her Chou1,2.
1Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan;
2Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
Purpose: To analyze the effects and pathways of the factors on uric acid nephrolithiasis.
Materials and Methods: We analyzed data from 3200 patients with upper urinary tract calculi and stone analysis in Kaohsiung Medical University Hospital between January 2004 and November 2016. The patients without precise medical history and laboratory tests were excluded. Factors including age, gender, diabetes mellitus (DM), body mass index (BMI), estimated glomerular filtration rate (eGFR), hypertension, stone symptoms, gout, occupation, diet, 24 hours urine PH level, 24 hours urine specific gravity, and bacteriuria were analyzed by structural equation modeling (SEM).
Results: Totally, 1098 patients with nephrolithiasis were included in this study. In these patients, 146 patients had uric acid nephrolithiasis. Urine PH level (estimate:-0.217, P value <0.001), DM (estimate: 0.097, P value =0.001), gout (estimate: 0.101, P value =0.016), and estimated glomerular filtration rate (eGFR) (estimate: -0.227, P value <0.001) were found to have a statistically significant direct effect on the development of uric acid nephrolithiasis. Besides, DM (estimate: 0.013, P value =0.026), eGFR (estimate: 0.002, P value <0.001), male gender (estimate: 0.001, P value =0.017), and body mass index (BMI) (estimate: 0.002, P value =0.001) were found to have significant indirect effect which was mediated by lower urine PH level.
Conclusions: We conclude that low urine PH level, DM, gout, impaired renal function, high body mass index, and male gender are risk factors for development of uric acid nephrolithiasis. Among them, male gender, high BMI, DM, impaired renal function could have effect on the development of uric acid stone mediated by low urine PH level. In these patient, we should monitor urine PH level and arrange urine alkalization. Low urine PH level, DM, impaired renal function, and gout are direct risk factors of uric acid nephrolithiasis. Controlling DM, kidney disease, and uric acid metabolism disorders should also be considered in the patients with uric acid nephrolithiasis. The survey of these factors are also suggested for the patients with uric acid nephrolithiasis. In the future, more animal studies and researches should be performed for the direct relationship between these factors and uric acid nephrolithiasis.