泌尿系结石与冠脉病变关系的研究进展

Research Progress on the Relationship between Urolithiasis and Coronary Artery Lesions

摘要: 泌尿系结石是一种全身性代谢异常疾病，与心血管病变、糖尿病及肥胖症等慢性疾病密切相关。流行病学证据表明，结石患者未来发生冠心病、心肌梗死等心血管事件的风险显著增加，其内在机制涉及高血压、糖尿病、肥胖等共同代谢风险因素，以及系统性炎症、内皮功能障碍和异位钙化等全身性病理过程。然而，现有研究未能充分探讨泌尿系结石的内在异质性，尤其是不同成分结石(如草酸钙、尿酸、磷酸铵镁、胱氨酸结石)具有不同的病理生理基础，其对心血管系统的影响机制可能存在显著差异。因此，肾结石史应被视为心血管风险的高危因素，临床需从全身视角加强对这类患者的综合评估与管理。在临床实践中，需进一步明确如何量化结石相关的心血管风险，例如是否应据此调整降脂或降压治疗阈值，以及针对不同复发类型结石患者启动心血管筛查的具体策略。

Abstract: Urinary calculi is a systemic metabolic disorder closely related to chronic diseases such as cardiovascular diseases, diabetes, and obesity. Epidemiological evidence shows that patients with calculi have a significantly increased risk of future cardiovascular events such as coronary heart disease and myocardial infarction. The underlying mechanism involves common metabolic risk factors such as hypertension, diabetes, and obesity, as well as systemic inflammatory processes, endothelial dysfunction, and ectopic calcification. However, current studies have not fully explored the intrinsic heterogeneity of urinary calculi, especially that different types of calculi (such as calcium oxalate, uric acid, magnesium phosphate ammonium, and cystine calculi) have different pathological physiological bases, and their impact mechanisms on the cardiovascular system may be significantly different. Therefore, a history of kidney stones should be regarded as a high-risk factor for cardiovascular diseases. Clinically, it is necessary to conduct comprehensive assessment and management of such patients from a systemic perspective. In clinical practice, it is necessary to further clarify how to quantify the cardiovascular risk related to calculi, such as whether the threshold for lipid-lowering or blood pressure-lowering treatment should be adjusted accordingly, and specific strategies for initiating cardiovascular screening for patients with different recurrence types of calculi.