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  

Effects of two different surgical methods on serum Cys-c, NGAL, Kim-1, coagulation function, MDA and SOD levels in patients with renal calculi

作　　者：康峰 杜丽娜 KANG Feng;DU Lina(Department of Urology,The 986th Hospital of the People’s Liberation Army Air Force(Xi’an 710054))

机构地区：[1]空军第986医院泌尿外科,西安710054

出　　处：《陕西医学杂志》2019年第5期564-568,共5页Shaanxi Medical Journal

基　　金：国家自然科学基金资助项目(30973000)

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。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).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 andα-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.

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 

分 类 号：R691.4[医药卫生—泌尿科学]