摘要
目的:探讨不同灌注压下上尿路腔内碎石术后肾损伤患者尿液肾损伤分子-1(KIM-1)、血清半胱氨酸蛋白酶抑制剂(Cys-C)和降钙素原(PCT)的变化。方法:选取本院收治的行微创经皮肾镜碎石术(MPCNL)、输尿管镜碎石治疗的128例上尿路结石患者作为研究对象,采用酶联免疫吸附双抗体夹心法(ELISA)分别测定患者术前2小时和术后2、12、24、48、72小时的尿液KIM-1和血清Cys-C水平,采用电化学发光法检测患者术前2小时和术后2、4、6、12小时的血清PCT浓度。以术中灌注压力≥13.33kPa为高压组,<13.33kPa为低压组,分析两组患者术前和术后KIM-1、Cys-C和PCT水平的变化及其与灌注压的相关性。结果:两组患者术前2小时和术后2小时的KIM-1和Cys-C水平差异无统计学意义(P>0.05)。两组患者术后12、24、48和72小时各时间点的KIM-1和Cys-C水平均显著高于术前,术后12、24、48和72小时各时间点高压组患者的KIM-1和Cys-C水平均显著高于低压组(P<0.05)。术后4、6和12小时各时间点高压组患者的血清PCT水平均显著高于低压组。KIM-1、Cys-C和PCT水平均与灌注压存在显著正相关关系(r=0.628,0.592,0.571,P<0.01)。结论:肾损伤指标KIM-1和Cys-C、感染指标PCT均与灌注压密切相关;在确保手术疗效的情况下,最高灌注压为13.33kPa,能降低肾损伤和感染的发生。
Objective：To study the changes of urine kidney injury molecule-1（KIM-1）,cystatin C（Cys-C）and procalcitonin（PCT）in patients with renal injury after upper urinary tract lithotripsy under different perfusion pressure.Method：One hundred and twenty-eight cases with upper urinary tract calculi treated with MPCNL or ureteroscopic lithotripsy were selected as the research objects.The levels of urine KIM-1and serum Cys-C of preoperative 2hand postoperative 2,12,24,48 and 72hwere measured by ELISA.The concentrations of serum PCT of preoperative 2hand postoperative 2,4,6and 12 hwere detected by the method of electrochemical luminescence.The changes of KIM-1,Cys-C and PCT levels of the two groups before and after operation were analyzed,and the correlation with the perfusion pressure were analyzed.Result：There was no significant difference in the levels of KIM-1and Cys-C between the two groups in preoperative 2hand postoperative 2hdata（P〉0.05）.The KIM-1and Cys-C levels of postoperative 12,24,48 and 72hdata of the two groups were significantly higher than those of preoperative data.The KIM-1and Cys-C levels of postoperative 12,24,48 and 72hof the high pressure group were significantly higher than those of low pressure group（P〈0.05）.The PCT levels of postoperative 4,6and 12 hof the high pressure group were significantly higher than those of low pressure group.The levels of KIM-1,Cys-C and PCT had a significant positive correlation with perfusion pressure（r=0.628,0.592,0.571,P〈0.01）.Conclusion：KIM-1,Cys-C and PCT are closely related to perfusion pressure.When the highest perfusion pressure is 13.33 kPa,it can reduce the renal injury and infection.
作者
赵淮平
夏术阶
汤晓晖
邵怡
朱洪祥
钱雄贤
仇军
ZHAO Huaiping XIA Shujie TANG Xiaohui SHAO Yi ZHU Hongziang QIAN Xiongzian QIU Jun(Department of Urology, Luodian Hospital of Baoshan District, Shanghai, 201908, China Department of Urology, Shanghai First People＇s Hospital)
出处
《临床泌尿外科杂志》
2016年第9期828-831,共4页
Journal of Clinical Urology
基金
上海市宝山区科委课题(编号13-E-38)
