ESWL前后肾损伤生化指标变化的临床研究

发布时间：2018-04-20 01:30

本文选题：体外冲击波碎石 + 早期肾损伤　；参考：《宁夏医科大学》2015年硕士论文

【摘要】：目的:对体外震波碎石术(ESWL)治疗的泌尿系结石患者进行碎石前后生化指标的检测,以寻求较好的早期预测ESWL肾损伤的生化检测指标,并判断肾损伤及修复情况和为两次ESWL术的间隔时间提供实验室依据。方法:筛选2014年2月1日到2014年5月31日来我院治疗的60例行ESWL术的肾结石患者,分别收集患者术前及术后0h,6h,12h,24h,48h,1w,2w尿液标本,测定其尿胱抑素C(Cys C)、尿β2-微球蛋白(β2-MG)、尿α1-微球蛋白(α1-MG)表达,并进行统计学分析。结果:60例患者ESWL术后各项生化指标较术前均有明显的变化,且呈现一定的规律性。胱抑素C在ESWL术后6小时出现明显上升,差异存在统计学意义(P0.05),6小时以后仍然呈上升趋势,到术后24h时到达最高点,相较术前存在统计学意义(P0.05),尿胱抑素C含量在24h以后出现缓慢下降,48h时的尿胱抑素C水平较术前仍有统计学意义(P0.05),患者术后1W随访的尿胱抑素C的含量已经明显降低,但较术前水平仍有统计学差异(P0.05),术后2W随访时,尿胱抑素C的含量已经降至接近术前水平,较术前已无统计学差异(P0.05)。β2-微球蛋白在术后24h出现升高,较术前有统计学差异(P0.05),48h时到达峰值,然后下降,到术后1W随访时降至接近正常水平,较术前无统计学差异(P0.05),2W随访时降至更低水平。α1-微球蛋白也是在术后24h出现升高,较术前有统计学差异(P0.05),48h达峰,1W随访时降至正常水平,差异无统计学意义(P0.05)。结论:本实验表明,尿胱抑素C较其它2种指标能够更早的发现早期肾损伤,并且呈现一定的规律性,具有较高敏感度,为临床诊治肾损伤提供客观依据;β2-微球蛋白和α1-微球蛋白也能发现早期肾损伤,但是敏感性稍差;本研究认为术后2W内不宜再次行碎石术。
[Abstract]:Objective: to detect the biochemical indexes before and after lithotripsy in patients with urolithiasis treated with extracorporeal shock wave lithotripsy (ESWL) in order to find a better biochemical index for early prediction of ESWL renal injury. Renal injury and repair were evaluated and laboratory data were provided for the interval between two ESWL procedures. Methods: 60 patients with renal calculi treated in our hospital from February 1, 2014 to May 31, 2014 were selected. Urine samples were collected from 60 patients with renal calculi before and after operation. The expression of cystatin (C(Cys), 尾 _ 2-microglobulin (尾 _ 2-MGG) and 伪 _ 1-microglobulin (伪 _ 1-MG) in urine were measured and analyzed statistically. Results the biochemical indexes after ESWL in 60 cases were significantly different from those before operation and showed certain regularity. Cystatin C increased significantly at 6 hours after ESWL, and the difference was statistically significant (P 0.05) after 6 hours, and reached the highest point at 24 hours after ESWL. The level of urinary cystatin C decreased slowly after 24 hours. The level of urinary cystatin C at 48 hours after operation was significantly higher than that before operation (P 0.05). The level of urinary cystatin C in the patients followed up 1 week after operation had been significantly decreased. However, there was still significant difference in the level of cystatin C between before and after operation (P 0.05). At the follow-up of 2 weeks after operation, the level of urinary cystatin C had decreased to close to the preoperative level, and there was no significant difference between the two groups before and after operation (P 0.05). 尾 2-microglobulin increased 24 hours after operation. There was a significant difference between the two groups at 48h, then decreased, and then decreased to the normal level at 1W follow-up, which was lower than that at 2W. 伪 1-microglobulin also increased 24 hours after operation. There was a significant difference between the two groups at the end of 48h and the normal level was decreased to the normal level at the end of 48h follow-up. There was no significant difference between the two groups (P 0.05). Conclusion: this experiment shows that urinary cystatin C can detect early renal injury earlier than the other two indexes, and has a certain regularity and high sensitivity. This study provides an objective basis for clinical diagnosis and treatment of renal injury, 尾 2-microglobulin and 伪 1-microglobulin can also detect early renal injury, but the sensitivity is slightly poor.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R692

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