重复体外冲击波碎石引起兔肾组织结构的变化研究  

Structural changes of renal tissue caused by repeated ESWL

作　　者：刘建民[1] 李振[1] 汪盛[1] 王凤超[1] 承泽农[1] 李庆文[1] 

机构地区：[1]蚌埠医学院第一附属医院泌尿外科,安徽蚌埠233004

出　　处：《中华全科医学》2016年第12期2027-2030,共4页Chinese Journal of General Practice

摘　　要：目的本实验探讨重复体外冲击波碎石(ESWL)引起兔肾脏组织结构的变化情况,分析治疗次数与累积损伤的量效关系,了解多次重复ESWL治疗可以对肾脏功能造成不可逆转的损害的过程。指导临床结石的治疗,限制ESWL治疗次数,预防、减少严重的肾功能损害。方法实验动物、分组及ESWL实验条件同前期研究。ESWL结束后,处死实验兔,取出肾脏,进行病理学检查。切片观察肾脏组织结构变化,HE、Masson染色,计数100倍视野平均肾小球数、胶原纤维的变化,免疫组化染色检测TGF-β_1及Ⅳ型胶原表达情况。结果 1重复ESWL引起肾单位损伤,随着ESWL次数的增加,出现纤维化改变,逐渐增加。2100倍视野平均肾小球数量在不同ESWL治疗组及对照组间差异有统计学意义(P<0.000 1)。ESWL 6次后,肾小球数量即有明显的减少,呈现组织纤维化,随着ESWL次数的增加,纤维化程度逐渐加重。3TGF-β_1及Ⅳ型胶原的阳性表达程度,各组比较差异有统计学意义。ESWL 4次后,表达程度即明显增多,并且随着ESWL的次数增加而增加。结论多次、重复ESWL对肾脏造成损害,且具有累积性,4次ESWL后出现TGF-β_1及Ⅳ型胶原表达的显著增加,即预示将要发生肾脏组织发生纤维化,使肾单位发生永久性、不可逆转性的结构改变,因此,应该严格掌握肾结石ESWL的指征,控制同侧肾脏ESWL的治疗次数,减少肾脏功能的累积性损伤,最大限度地保护肾功能。Objective To access the progressive, permanent, and irreversible damage of kidney of rabbit for repeat ESWLs, seek digital times-effect relationship of ESWL,learn the processes of eternal and irreversible damages of renal function caused by multiple and repeat ESWLs, and guide ESWL for the patient with recurrent or complicated kidney stone to reduce renal damage and prevent severe renal function damage. Methods Animal and design of the studies are same as study I. We killed the rabbits, removed the kidney, and performed historical examinations our earlier after ESWL, observed changes of histological structure and fibrosis of glomeruli and tubules ; digitized the numbers of glomeruli under microscope by H. E. and Masson stain;detected expression of TGF-β1, collagen IV by immunohistochemical stain under microscope. Results （1）Accumulated damage of kidney occurred after repeat ESWL with structural changes of nephron, and fibrolifi- cation of glomeruli and tubules occurred gradually with the increasing of ESWL times. （2）There are significant difference on average numbers of glomerular under 100 times microscope fields between ESWL group and control group. After 6- times of ESWL, numbers of glomeruli decreased significantly, and degree of renal fibrosis gradually enhanced with in- creased ESWL times. （3）There were significant differences in comparison of degree of TGF-β1 and Collagen IV expression increased, and the degree markedly enhanced after 4 times of ESWL, and as the times of ESWL increasing, the degree increased gradually. Conclusion Multiple, repeat ESWLs can cause accumulated damage of kidney with fibrosis;After 4- times ESWLs ,expressions of TGF-β1 and Collagen IV increased ,these predicted severe fibriliflcation would occur, which can cause permanent, irreversible kidney damage. ESWL should be performed with strict indications for renal stone patients and control ESWL within 4 times to prevent the irreversible accumulated damage of kidney and protect renal function maximum.

关 键 词：重复ESWL 兔 肾累积性损伤 组织学 免疫组化 

分 类 号：R691.4[医药卫生—泌尿科学] R454.3[医药卫生—外科学]