Exploration On The Relationship Between Metabolic Syndrome And Its Components And Kidney Stone Composition

Objective:The population of metabolic syndrome is increasing gradually,and its influence on renal calculi deserves further study.This topic aims to explore the influence of metabolic syndrome and its components on renal calculi,and the correlation with renal calculi components.Methods:From January 2017 to December 2018,356 kidney stone patients admitted to our hospital were studied.There were 216 males and 140 females,aged 16-78 years.Ultrasonography,Abdominal X-ray film or urinary CT were used to diagnose renal calculi,of which 291 cases were newly diagnosed,15 cases recurred and 50 cases remained(The initial consultation time of the re-examination patient is not within this statistical cycle).Ultrasonic localization of extracorporeal shock wave lithotripsy was performed in 148 cases,X-ray localization of extracorporeal shock wave lithotripsy in 106 cases,ureteroscope holmium laser lithotripsy in 62 cases,and percutaneous nephrolithotomy in 40 cases.Of 356kidney stones in this study,173 patients were defined as metabolic syndrome according to diagnostic criteria,and were set as observation group(metabolic syndrome group)and 183as control group(simple stone group).In the observation group,there were 102 males and 71females with an age of 57.4±13.3 yeras.The number of patients in the control group was 113males and 70 females,and the age of patients was 54.5±14.9 years.Stone infrared spectrum automatic analysis system is adopted for analysis,and calcium oxalate stone,carbonate apatite,uric acid stone,ammonium magnesium phosphate hexahydrate stone,brushite stone and other main categories are classified according to urinary stone components.Body mass index,abdominal circumference,systolic blood pressure,diastolic blood pressure,fasting blood glucose,triglyceride,high density lipoprotein cholesterol,uric acid are the metabolic indicators.The data analysis and processing in this experiment were carried out by SPSS17.0software and Excel2003.The P-value was calculated by using independent t-test,Mann-Whitney U test,the Pearson?~2-test and Cochran-Mantel-Haenszel test.Multiple logistic regression analysis was used to determine the OR for having uric acid stones according to metabolic syndrome and its components.P value less than 0.05 is considered to have statistical significance.Results:356 patients with renal calculi,the average age was 55.9 years old,ranging from 16 to78 years old.173 cases(48.6%);102 males and 71 females)were diagnosed as metabolic syndrome.There were significant differences in age,body mass index,waist circumference,blood pressure,triglyceride,high density lipoprotein cholesterol and fasting blood glucose between the two groups(P<0.001),and triglyceride(P=0.002).the level of uric acid in patients with metabolic syndrome was significantly higher than that in patients without metabolic syndrome(5.7±1.6 vs 5.0±1.5,P<0.001).For patients previously diagnosed with diabetes,the observation group is nearly twice as high as the control group(59.5%vs.29.0%).The main stone components are calcium oxalate(71.4%),carbonate apatite(7.9%),uric acid(15.4%),ammonium magnesium phosphate hexahydrate stone(3.9%),brushite stone(1.4%).In general,the proportion of uric acid calculi was significantly higher in patients with metabolic syndrome than in patients without metabolic syndrome(19.6%vs11.2%;P?=?0.002)?However,the proportions of calcium oxalate,carbonate apatite,ammonium magnesium phosphate hexahydrate stone and brushite stone are not different between the two groups.173(48.6%)and 248(69.7%)patients were diagnosed as metabolic syndrome and abdominal obesity respectively.Uric acid calculi accounted for 19.6%and16.1%of patients with metabolic syndrome and abdominal obesity respectively.The proportion of uric acid stones gradually increased with the increase of the scores of each component of metabolic syndrome,and the proportion of uric acid stones increased from10.2%of one component to 33.3%of the four components(P<0.001).Compared with no metabolic syndrome,the presence of metabolic syndrome increases the OR value of uric acid calculi by 93%.Triglyceride(OR=2.59;95%CI:1.71-3.91;P<0.001),high density lipoprotein cholesterol(OR=0.62;95%CI:0.41-0.93;P=0.022)and fasting blood glucose(OR=1.91;95%CI:1.25-2.92;P=0.003)was identified as an important risk factor associated with uric acid calculi.Waist circumference and blood pressure level are not independently related to the risk of uric acid calculi.After adjustment for age and sex,a slight decrease in OR was observed in three factors,namely metabolic syndrome(1.82;95%CI:1.19-2.79;P=0.006),triglyceride(2.13;95%CI:1.39-3.28;P=0.001)and fasting blood glucose(1.82;95%CI:1.19-2.80;P=0.006)?However,after adjustment for age and sex,HDL cholesterol was not correlated with OR value of uric acid calculi(0.73;95%CI:0.48-1.11;P=0.136)?Conclusion:Metabolic syndrome and its components are closely related to stone.Calcium oxalate stone is still the most important stone component in all patients.Uric acid stone is a minority in all kidney stone patients,but it is more common in stone formation with metabolic syndrome and is related to the quantity of metabolic components.Metabolic syndrome is associated with a significant increase in uric acid calculi,especially in patients with hyperglycemia and hypertriglyceridemia.Impaired fasting glucose and hypertriglyceridemia were independent risk factors for uric acid calculi.