肾盂压力增高对幼年猪肾脏的影响  

Effect of increased renal pelvis pressure on the kidney of young pigs

作　　者：李彦生[1] 于泽兴 韩修武[1] 张鑫[1] 朱绪辉[1] 李涛[1] 张鹏[1] 陈元浩[1] 李高 张小东[1] Li Yansheng;Yu Zexing;Han Xiuwu;Zhang Xin;Zhu Xuhui;Li Tao;Zhang Peng;Chen Yuanhao;Li Gao;Zhang Xiaodong(Department of Urology,Capital Medical University Beijing Chaoyang Hospital,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科,100020

出　　处：《中华实验外科杂志》2019年第1期103-106,共4页Chinese Journal of Experimental Surgery

摘　　要：目的观察肾盂压力(IPP)增高对幼年猪肾脏造成的影响。方法采用贵州小型猪作为研究对象,建立IPP模型。将IPP设置为0、30、60、90 mmHg 4个水平。在各个压力水平下,静脉注射超声造影剂后,使用超声造影(CEUS)测量左侧肾脏肾皮质血流灌注水平5 min,计算峰值强度(PI)和曲线下面积(AUC)定量计算肾脏皮质血流灌注量。超声造影测量肾皮质血流灌注完毕后,随后在每个压力水平下,在同侧肾脏用超声造影行逆行肾盂造影5 min。最后将左侧肾脏取下送病理学检查。统计学分析在各个压力水平下肾脏血流变化。结果10例猪肾脏模型中,4个IPP水平下的PI不全相同(F=58.947,P<0.01),其中30 mmHg与0 mmHg两组无差异统计学意义(t=1.984,P>0.05);60 mmHg与0 mmHg两组有差异统计学意义(t=5.332,P<0.01),且PI(0 mmHg)>PI(60 mmHg);90 mmHg与0 mmHg两组有差异统计学意义(t=10.507,P<0.01),且PI(0 mmHg)>PI(90 mmHg)。秩和检验和显示4个IPP水平下的曲线下面积(AUC)(χ^2=28.876,P<0.01)不全相同。其中30 mmHg与0 mmHg两组有差异统计学意义(Z=-2.497,P<0.05);60 mmHg与0 mmHg两组有差异统计学意义(Z=-2.701,P<0.05),;90 mmHg与0 mmHg两组有差异统计学意义(Z=-2.803,P<0.05),且AUC(0 mmHg)>AUC(90 mmHg)。PI和AUC均提示肾脏血流随着IPP的增高迅速下降。逆行肾盂造影显示60%的实验对象出现了造影剂穿入肾脏皮质的现象,病理显示肾皮质出现小裂伤。病理提示70%的肾小囊内出现了纤维素渗出。但是所有的大体标本未见到明显的肾破裂现象。结论在明显的肾脏损伤出现之前,增高的IPP已经对肾脏的生理出现了影响,并造成了微小病理性的隐匿性损伤和病理上的改变。对于小儿患者来说,此种隐匿性损伤尤其应当引起临床医师的足够重视。微创治疗肾结石已经成为临床医生的主流选择,目前主要包括输尿管软镜和经皮肾镜碎石取石术。使用这两种微创技术治疗小儿肾结石�Objective To study what impact the elevated intrarenal pelvic pressure (IPP) may have on the childhood kidney.Methods The childhood Guizhou miniature pigs were taken as the subjects and the elevated IPP animal models were established. The IPP pressure was set at levels of 0, 30, 60, 90 mmHg (1 mmHg=0.133 kPa). After the contrast agent was administered intravenously, the left renal cortical microvasculature blood perfusion was measured using contrast-enhanced ultrasonography (CEUS) at each pressure level respectively for 5 minutes. The retrograde pyelography by CEUS was performed at each pressure level for 5 minutes on the same side after the renal cortical microvasculature blood perfusion measurement. Finally the left kidney specimens were sent for pathology. Statistical study was performed on the cortical microvasculature perfusion difference between the various IPP level of 0, 30, 60, 90 mmHg.Results In the 10 repetitions, analysis of variance suggested the Peak intensity (PI) under 4 IPP levels was not all the same statistically (F=58.947, P<0.01). There was no statistical difference between the PI under 0 mmHg level and the PI under 30 mmHg (t=1.984, P>0.05);AS for PI, there was statistical difference between the 60 mmHg level and 0 mmHg level (t=5.332, P<0.01). The PI between 0 mmHg level and 90 mmHg level was different statistically (t=10.507, P<0.01). Rank sum test showed that the area under curve (AUC) under four IPP levels was statistically different (χ^2=28.876, P<0.01). Compared with AUC under 0 mmHg level, the AUC under 30, 60, 90 mmHg level was statistically different respectively. AS for AUC, there was statistical difference between 0 mmHg and 30 mmHg (Z=-2.497, P<0.05). there was statistical difference between the 60 mmHg level and 0 mmHg level (Z=-2.701, P<0.05). The AUC between 0 mmHg level and 90 mmHg level was different statistically (Z=-2.803, P<0.05). Both the PI and the AUC indicated that the renal blood flow decreased rapidly with the increase of IPP. The retrograde pyelography by CEUS sug

关 键 词：结石 肾盂压 肾损伤 

分 类 号：R692[医药卫生—泌尿科学]