[1]康 峰,杜丽娜.两种不同术式对肾结石患者血清CysC、NGAL、Kim1、凝血功能和MDA、SOD水平的影响*[J].陕西医学杂志,2019,(5):564-568.
　KANG Feng,DU Lina..Effects of two different surgical methods on serum Cysc, NGAL, Kim1,coagulation function, MDA and SOD levels in patients with renal calculi[J].,2019,(5):564-568.
点击复制

两种不同术式对肾结石患者血清CysC、NGAL、Kim1、凝血功能和MDA、SOD水平的影响*
分享到：

《陕西医学杂志》[ISSN:1000-7377/CN:61-1281/TN]

卷:
期数:
2019年5期
页码:
564-568
栏目:
临床研究
出版日期:
2019-05-05

文章信息/Info

Title:
Effects of two different surgical methods on serum Cysc, NGAL, Kim1,coagulation function, MDA and SOD levels in patients with renal calculi
文章编号:
DOI: 10.3969/j.issn.10007377.2019.05.006
作者:
康 峰; 杜丽娜
空军第986医院泌尿外科（西安710054）
Author(s):
KANG Feng;  DU Lina.
Department of Urology, The 986th Hospital of the People’s Liberation Army Air Force (Xi’an 710054)
关键词:
肾结石; 外科学; 经皮肾镜; 输尿管软镜; 凝血功能; 氧化应激
Keywords:
Key words Renal calculi;  Surgery; Percutaneous nephroscopy;  Ureteroscopy;  Coagulation function;  Oxidative stress
分类号:
R691.4
文献标志码:
A
摘要:
摘 要 目的：比较经皮肾镜与输尿管软镜对肾结石患者血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、胱抑素C（CysC）、尿肾损伤分子1（Kim1）、凝血功能和超氧化物歧化酶（SOD）、丙二醛（MDA）水平的影响。方法：采用回顾性研究，收集105例肾结石患者的临床资料，根据患者手术方法的不同，分为经皮肾镜组（31例）与输尿管软镜组（74例）。比较两组患者手术相关指标、术前和术后24 h血清NGAL、CysC、Kim1、氧化应激指标SOD、MDA和凝血功能指标MA、αAngle、R、K及并发症发生情况的差异。结果：两组患者结石清除率比较，无统计学差异（P＞0.05）；输尿管软镜组术中出血量和住院时间较经皮肾镜组明显减少，而手术时间较经皮肾镜组明显延长（P＜0.01）。与术前相比，两组患者术后24 h血清Kim1、NGAL及CysC的水平均明显升高，但输尿管软镜组术后Kim1、NGAL及CysC的水平较经皮肾镜组明显下降（P＜0.05）。术后24 h，两组患者SOD的水平较术前均显著降低，MDA的水平较术前均显著增高，且输尿管软镜组术后SOD的水平较经皮肾镜组显著增高，MDA的水平较经皮肾镜组显著降低（P＜0.05）。相比术前，两组患者术后24 h时MA和αAngle均明显升高，R值和K值均明显降低，且输尿管软镜组术后MA和αAngle较经皮肾镜组明显下降，R值和K值较经皮肾镜组明显升高（P＜0.05）。两组患者肾包膜下血肿和发热等并发症总发生率比较，无统计学差异（P＞0.05）。结论：经皮肾镜与输尿管软镜对肾结石患者的碎石效果和安全性均相当，均具有较高的结石清除率，且并发症的发生均较少，但相比经皮肾镜治疗，应用输尿管软镜治疗对患者肾功能、氧化应激及凝血功能的影响较小，且可有效减少患者术中出血量，缩短住院时间，可作为临床治疗肾结石患者的选择术式。
Abstract:
Abstract Objective: To compare the effects of percutaneous nephroscopy and flexible ureteroscopy on serum neutrophil gelatinaseassociated lipocalin (NGAL), CystatinC (CysC), urinary kidney injury molecule1 (Kim1), coagulation function, superoxide dismutase (SOD), malondialdehyde (MDA) levels in patients with renal calculi. Methods: A retrospective study was conducted to collect the clinical data of 105 cases of renal calculi. According to the different surgical methods, the patients were divided into percutaneous nephroscopy group (31 cases) and flexible ureteroscopy group (74 cases). The differences of operation related indexes, serum NGAL, CysC, Kim1, oxidative stress index SOD, MDA and coagulation function index MA, αAngle, R, K and complications between the two groups were compared.Results: There was no significant difference in stone clearance rate between the two groups (P＞0.05). The bleeding volume and hospitalization time in the flexible ureteroscopy group were significantly less than those in the percutaneous nephroscopy group, while the operation time was significantly longer than that in the percutaneous nephroscopy group (P＜0.01). The serum levels of Kim1, NGAL and CysC were significantly higher in the two groups 24 hours after operation than those before operation, but the levels of Kim1, NGAL and Cysc in the flexible ureteroscopy group were significantly lower than those in the percutaneous nephroscopy group (P＜0.05).〖LM〗At 24 hours after operation, the levels of SOD and MDA in the two groups were significantly lower than those before operation, and the levels of SOD and MDA in the flexible ureteroscope group were significantly higher than those in the percutaneous nephroscope group (P＜0.05).Compared with preoperation, MA and αAngle increased significantly 24 hours after operation, R and K values decreased significantly,and MA and alphaAngle decreased significantly in the flexible ureteroscope group compared with the percutaneous nephroscopy group, R and K values increased significantly compared with the percutaneous nephroscopy group (P＜0.05). There was no significant difference in the total incidence of renal subcapsular hematoma and fever between the two groups (P＞0.05).Conclusion: Percutaneous nephroscopy and flexible ureteroscope have the same lithotripsy effect and safety in patients with renal calculi, which both have certain stone clearance rate and slight complications. However, compared with percutaneous nephroscopy, flexible ureteroscope has less influence on renal function, oxidative stress and coagulation function, and can effectively reduce the amount of blood in patients during operation and shorten the hospital stay, which can be used as the first choice for the treatment of renal calculi.

参考文献/References:

[1] Khan AH, Imran S, Talati J, et al.Fourier transform infrared spectroscopy for analysis of kidney systems[J]. Investig Clin Urol,2018,59(1):32-37. [2] Alkadhi H,Saltybaeva N.Lostopportunities: radiologists are not sufficiently using reduceddose CT for kidney stones[J]. Radiology,2018,286(2):590-591. [3] Patel SR,Nakada SY.The modern history and evolution of percutaneous nephrolithotomy[J].J Endourol,2015,29(2)：153-157. [4] 王安勇.输尿管软镜术与经皮肾镜碎石术治疗肾结石的临床疗效比较研究[J].实用心脑肺血管病杂志,2017,25(S1)：90-91. [5] 徐宝海,江 铎.标准与微通道经皮肾镜取石术治疗肾结石效果分析[J].陕西医学杂志,2018,47(1):29-31. [6] 江 锋,吴鹏飞.输尿管软镜下钬激光碎石术治疗肾结石的疗效和安全性研究[J].陕西医学杂志,2018,47(8):1000-1002. [7] 张会波,刘 凯,杜宏宏,等.四金化石汤对经皮肾镜联合输尿管镜治疗肾结石合并同侧输尿管结石疗效观察[J].陕西中医,2017,38(10):1439-1440. [8] Ma MC, Chen YS, Huang HS. Erythrocyte oxidative stress in patients with calcium oxalate stones correlates with stone size and renal tubular damage[J]. Urology,2014,83(2):510. [9] Donadio C.Effect of glomerular filtration rate impairment on diagnostic performance of neutrophil gelatinaseassociated lipocalin and Btype natriuretic peptide as markers of acute cardiac and renal failure in chronic kidney disease patients[J]. Crit Care,2014,18(1):R39. [10] 何 龙,李 昕,刘 龙,等. 泌尿系无症状结石手术安全性、有效性及术后肾功能变化的回顾性研究[J]. 解放军医药杂志,2015,27(6):24-27. [11] Sans L, Radosevic A, Quintian C, et al. Cystatin C estimated glomerular filtration rate to assess renal function in early stages of autosomal dominant polycystic kidney disease[J]. PLoS One,2017,12(3):e0174583. [12] Falahatkar S,Mokhtari G,Amin A,et al.Comparisonof the outcomes of complete supine percutaneous nephrolithotomy in patients with radiopaque and radiolucent kidney stones[J]. Turk Urol, 2017, 43 (4): 490--496.

相似文献/References:

[1]李少明,汤万荣,李 薇,等.双镜联合胆道内支架置入、胆总管一期缝合技术临床应用*[J].陕西医学杂志,2019,(1):13.
　LI Shaoming,TANG Wanrong,LI Wei,et al.Clinical application of double endoscopic combined with percutaneous transhepatic insertion of biliary stents and one stage suture technique of common bile duct[J].,2019,(5):13.
[2]葛文安,王盛兴,郭 涛,等.腹腔镜肾盂成形术与传统肾盂成形术治疗小儿肾积水疗效对比研究[J].陕西医学杂志,2019,(5):584.
　GE Wenan,WANG Shengxing,GUO Tao,et al.Comparative analysis of the effect of laparoscopic pyeloplasty and traditional pyeloplasty in children with hydronephrosis[J].,2019,(5):584.
[3]李克峰,王 静△,张建标.全腹膜外腹股沟疝修补网片固定术对腹股沟疝患者慢性疼痛及基质金属蛋白酶水平的影响*[J].陕西医学杂志,2019,(8):1013.
　LI Kefeng,WANG Jing,ZHANG Jianbiao..The effects of total extraperitoneal mesh repair on chronic pain and its effect on metalloproteinases[J].,2019,(5):1013.
[4]韦爱华,孙 园,南淑良,等.彩色多普勒超声检查对输尿管软镜碎石术患者肾动脉血流评价研究*[J].陕西医学杂志,2019,(9):1175.
　WEI Aihua,SUN Yuan,NAN Shuliang,et al.Effects of flexible ureteroscope lithotripsy as evaluated 〖JZ〗by color doppler ultrasonography at segmental renal arteries[J].,2019,(5):1175.
[5]赵 涛,梁亚萍,高腾飞△,等.经第12肋骨前路病灶清除自体髂骨植骨融合钢板螺钉内固定术治疗胸腰段脊柱结核临床研究*[J].陕西医学杂志,2019,(11):1481.
[6]罗培跃,陈 涛,邹 俊,等.纳米细菌诱导肾结石形成中肠道草酸降解菌变化初步研究[J].陕西医学杂志,2023,52(8):977.[doi:DOI:10.3969/j.issn.1000-7377.2023.08.008]
　LUO Peiyue,CHEN Tao,ZOU Jun,et al.Preliminary study on changes of oxalate-degrading bacteria in nanobacteria-induced kidney stone formation[J].,2023,52(5):977.[doi:DOI:10.3969/j.issn.1000-7377.2023.08.008]
[7]凌 峰,薛 珺,章 钟,等.微创经皮肾镜碎石取石术小剂量地塞米松干预对肾结石疗效影响价值研究[J].陕西医学杂志,2024,(8):1077.[doi:DOI:10.3969/j.issn.1000-7377.2024.08.015]
　LING Feng,XUE Jun,ZHANG Zhong,et al.Effect of low-dose dexamethasone intervention in minimally invasive percutaneous nephrolithotomy on the efficacy of kidney stones[J].,2024,(5):1077.[doi:DOI:10.3969/j.issn.1000-7377.2024.08.015]

备注/Memo

备注/Memo:
*国家自然科学基金资助项目（30973000）
更新日期/Last Update: 2019-05-07