绝经后女性肾结石患者骨密度变化及其相关因素分析

Analysis of bone mineral density changes and related factors in postmenopausal female patients with kidney stones

摘要

目的 绝经后女性因雌激素缺乏而面临肾结石与骨质疏松的双重风险，二者潜在的共同病理机制尚待阐明，本研究旨在探讨绝经后女性肾结石患者的骨密度变化并分析其相关因素。方法 回顾性分析浙江省人民医院2023年1月-2025年8月收治的87例绝经后女性肾结石患者的病例资料，根据骨密度检测结果分为骨密度下降组（n=65）与骨密度正常组（n=22），对比分析两组的结石成分、骨代谢指标、肾功能指标和相关细胞因子水平。结果 在绝经后女性肾结石患者中，骨密度下降组空腹尿钙/肌酐比值（Ca/Cr）、尿 N-乙酰-β-D 氨基葡萄糖苷酶（NAG）、血清白细胞介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）水平较骨密度正常组明显升高（P＜0.05）。骨密度下降组含钙结石的比例（95.4%）明显高于骨密度正常组（68.2%）。结论 绝经后雌激素水平降低通过干扰钙代谢转换及肾小管功能，造成高钙尿症和骨密度降低，构成了骨质疏松与肾结石发生的共同病理基础，空腹尿Ca/Cr、尿 NAG、血清IL-6和 TNF-α这些指标可能与共病相关，可以作为绝经后骨质疏松和肾结石发生的共同指标进行积极监测，有助于绝经后女性患者的个体化诊疗和综合管理。

Abstract

Objective Postmenopausal women face dual risks of kidney stones and osteoporosis due to estrogen deficiency，whose underlying pathological mechanisms remain unclear. This study aims to investigate the changes of bone mineral density（BMD）in postmenopausal women with kidney stones and to analyze the related factors. Methods The clinical data of 87 postmenopausal women with kidney stones admitted to Zhejiang Provincial People's Hospital during Jan. 2023 and Aug. 2025 were retrospectively analyzed. According to the BMD measurement results，they were divided into the decreased BMD group（n=65）and normal BMD group（n=22）. The stone composition，bone metabolic indicators，renal function indicators，and related cytokine levels were compared between the two groups. Results The fasting urinary calcium to creatinine ratio（Ca/Cr），urinary N-acetyl-β-D-glucosaminidase（NAG），serum interleukin-6（IL-6），and tumor necrosis factor-α（TNF-α）levels in the decreased BMD group were significantly higher than those in the normal BMD group（P＜0.05）. The proportion of calcium-containing stones in the decreased BMD group（95.4%）was significantly higher than that in the normal BMD group（68.2%）. Conclusion The decrease in estrogen level after menopause disrupts calcium metabolic turnover and renal tubular function，leading to hypercalciuria and decreased BMD，which constitutes the common pathological basis for the occurrence of osteoporosis and kidney stones. Fasting urinary Ca/Cr，urinary NAG，serum IL-6 and TNF-α may be associated with comorbidity，which can be actively monitored as common risk factors for the occurrence of osteoporosis and kidney stones in postmenopausal women，thus facilitating individualized diagnosis，treatment，and comprehensive management of such patients.

关键词

绝经后骨质疏松 / 肾结石 / 骨密度

Key words

postmenopausal osteoporosis / kidney stones / bone mineral density

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基金资助

贵州省科技成果应用及产业化项目（临床专项项目）(黔科合成果LC〔2026〕一般278)