摘要
目的 探讨抗氧化维生素和钙通道阻滞剂对体外冲击波碎石术 (ESWL)所致儿童急性肾损伤的保护作用。方法 2 6例肾盂内结石患儿 ,男 1 8例 ,女 8例 ;年龄 7～ 1 2岁 ,平均 9.8岁。右肾结石 1 1例 ,左肾结石 1 5例 ,结石直径 6～ 1 3mm ,平均 8.6mm。经腹部平片和B超确诊。血清肌酐、尿素氮值均在正常范围。常规静脉尿路造影检查 ,显示结石侧肾无积水或轻度积水 ,轻度肾积水者其远端尿路通畅无梗阻 ;对侧肾功能正常。 2 6例接受ESWL的儿童肾结石患者随机分为用药组和对照组 ,每组 1 3例。用药组在术前 3d口服维生素E、C和硝苯地平 ,对照组不用药物。观察术前 1d、后 1d、后 1周 2 4h尿内皮素 (ET 1 )、尿丙二醛 (MDA)和尿N 乙酰 β D氨基葡萄糖苷酶 (NAG)变化 ,同时测定肾内血管阻力指数 (RI)。结果 对照组术后 1dET 1 (44.84± 1 6 .2 4 )ng/L、MDA(3 .97± 1 .1 6)nmol/L、NAG(56 .42± 1 2 .34)u·g- 1 ·cr- 1 和RI(0 .70 2± 0 .0 38)比术前及用药组明显增高 (P <0 .0 1 ) ;术后 1周MDA、NAG及RI仍高于术前水平 (P <0 .0 1 )。用药组术后 1d ,ET 1、MDA和RI较术前无明显增高 (P >0 .0 5) ;NAG较术前增高 (P <0 .0 5) ,但 1周内恢复术前水平。结论 抗氧化维生素和钙通道阻滞剂能减轻ESWL的脂质过?
Objective To determine the role of antioxidant vitamins and calcium channel blockers in pr eventing or alleviating acute renal injury in children during extracorporeal sho ck wave lithotripsy (ESWL). Methods Twenty-six children with renal calculi were recr uited in the prospective without anaesthesia ESWL study. They were randomized i nto the therapeutic group and control group (13 cases for each group). In the t herapeutic group, vitamin E?C and nifedipine were given orally for 3 days prior to ESWL, while the control group received no medication. 24 h urine samples were analyzed for endothelin (ET-1), malonyldehyde (MDA) and N-acetyl-a-D-g lucosamonidase (NAG). Doppler ultrasonography was carried out to measure the intrarenal vascular resistance index (RI) of the treated kidney before, 1 and 7 days after ESWL. The results were compared between the groups and within the groups. Results In the control group, a significant elevation of the excretion of ET,MDA, NAG and increase of RI were observed 1 day after ESWL c ompared with those before ESWL ( P < 0.01 ) and with those in the drugs g roup 1 day after ESWL ( P < 0.01 ) respectively; MDA, NAG and RI hadn't re turned to the baselines of pre-ESWL on the 7th day after ESWL. In the therapeu tic group, NAG was significantly higher one day after ESWL than before ( P < 0.05 ) and returned to the baseline of pre-ESWL within one week after; ET, MDA and RI increased mildly without statistical significance 1 day after ESWL th at compared with pre- ESWL ( P > 0.05 ). Conclusions Antioxidant vitamins combined with calcium ch a nnel blockade pretreatment may have a protective function by alleviating the act ion of lipids oxidation, improving the blood perfusion of the kidney and decreas ing the degree of renal injury induced by ESWL in renal calculous disease in chi ldren.
出处
《中华小儿外科杂志》
CSCD
北大核心
2003年第4期322-325,共4页
Chinese Journal of Pediatric Surgery
