肾结石经皮肾镜术后急性肾损伤患者术前血清和尿神经导向因子的水平及其临床意义  

Levels of serum and urinary netrin-1 in patients with acute kidney injury after percutaneous nephrolithotomy and its clinical significance

作　　者：侯颉玢 张书玥 谌卫[1] 彭泳涵[3] 李凌[3] 高小峰[3] 郭志勇[1] HOU Jiebin;ZHANG Shuyue;CHEN Wei;PENG Yonghan;LI Ling;GAO Xiaofeng;GUO Zhiyong(Department of Nephrology, Shanghai Changhai Hosptial, Shanghai 200433, Chin)

机构地区：[1]上海长海医院肾内科,上海200433 [2]海军军医大学学员旅 [3]上海长海医院泌尿外科,上海200433

出　　处：《上海医学》2018年第2期100-103,共4页Shanghai Medical Journal

基　　金：国家自然科学基金(81573759;81403261;81670642;81500531);第二军医大学创新能力孵化基地(FH2017182)

摘　　要：目的探讨肾结石患者术前血清和尿神经导向因子(Netrin-1)水平与经皮肾镜术后急性肾损伤(AKI)的关系,并分析术后AKI发生的危险因素。方法选择于2014年1月—2016年12月在上海长海医院泌尿外科住院行经皮肾镜术的肾结石患者334例,测定所有患者术前血生化指标(包括血清肌酐、总胆固醇、低密度脂蛋白胆固醇、三酰甘油)、血清Netirin-1水平和尿Netrin-1/尿肌酐比值,以及术后血清肌酐水平。根据患者术前与术后血清肌酐水平的变化,诊断是否发生AKI,将患者分为AKI组(49例,14.7%)和非AKI组(285例,85.3%)。采用多因素logistic回归分析术后AKI发生的危险因素。结果 AKI组患者术前血清肌酐水平显著高于非AKI组(P<0.05),糖尿病和高血压患者比例均显著高于非AKI组(P值均<0.01)。AKI组术前血清Netrin-1水平和尿Netrin-1/尿肌酐比值分别为11.5(6.5,13.5)ng/L和78.1(36.5,96.8)ng/g,均显著高于非AKI组的5.2(4.6,5.9)ng/L和49.6(27.1,71.5)ng/g(P值均<0.05)。多因素logistic回归分析显示,术前血清Netrin-1水平(OR=1.062,95%CI为1.005~1.179,P=0.036)和糖尿病(OR=2.138,95%CI为1.106~7.195,P=0.027)为肾结石患者经皮肾镜术后AKI发生的独立危险因素。结论术前血清和尿Netrin-1水平与肾结石患者经皮肾镜术后AKI的发生有关,术前血清Netrin-1水平和糖尿病是术后AKI发生的独立危险因素。Objective To investigate the correlation between preoperative serum and urinary levels of netrin-1 and the incidence of acute kidney injury （AKI） after percutaneous nephrolithotomy, and to analyze the risk factors of postoperative AKI, Methods Clinial data of 334 patients with nephrolithiasis treated by percutaneous nephrolithotomy （PCNL） from January 2014 to December 2016 in the Department of Urology of Shanghai Changhai Hospital were analyzed. The serum and urinary netrin-1 concentration and blood biochemical indexes including serum creatinine （sCr）, total cholesterol, low-density lipoprotein cholesterol and total triglyceride were measured before operation. Patients were divided into AKI group （49 cases, 14. 7%） and non-AKI group （285 cases, 85.3% ） according to the diagnosis of postoperative AKI. Multivariate logistic regression was used to analyze the risk factors of postoperative AKI. Results Preoperative sOr level and the proportion of patients with diabetes and hypertension in AKI group were significantly higher than those in non-AKI group （P〈0.05 or 0.01）. The levels of both serum netrin-1 and urinary netrin-1/UCr in AKI patients were 11. 5 （6. 5, 13.5） ng/L and 78. 1 （36.5, 96.8） ng/g, which were significantly higher than the levels in patients without AKI （5.21-4.6,5.91 ng/L and 49.61-27.1,71.51 ng/g. Multivariate logistic regression analysis showed that preoperative serum netrin-1 （OR = 1. 062, 95% CI： 1. 005- 1. 179, P = 0. 036） and diabetes mellitus （OR = 2. 138, 95% 01： 1. 106- 7. 195, P=0.027） were the independent risk factors of AKI after PCNL. Conclusion Preoperative serum and urinary levels of netrin-1 are significantly associated with the incidence of AKI after PCNL. Preoperative serum level of netrin-1 and diabetes are independent risk factors of postoperative AKI. （Shanghai Med J, 2018, 41 ： 100- 103）

关 键 词：肾结石 经皮肾镜术 急性肾损伤 尿神经导向因子 

分 类 号：R699.2[医药卫生—泌尿科学]