体外冲击波碎石对肾结石患者血浆一氧化氮的影响

Effects of Extracorporeal Shock Wave Lithotripsy on Nitric Oxide Levels

目的探讨体外冲击波碎石(ESWL)对肾结石患者血浆一氧化氮(NO)的影响及可能机制。方法选择2004年12月至2007年5月来我院泌尿科就诊,经X线或CT结合腹部B超确诊为肾结石无症状患者30例,观察ESWL前后肾结石患者血浆NO水平及尿酶(NAG,r-GT)、β2-微球蛋白(β2-MG)的变化。结果肾结石患者ESWL后即刻血浆NO值逐渐升高,出现两个峰值,分别见于ESWL后24h和7d,7d为最高值(P<0.05);ESWL后即刻尿酶NAG、γ-GT值逐渐升高,24h达高峰(P<0.05),72h尿γ-GT值降至ESWL前水平(P>0.05),而NAG在冲击后7d仍未恢复至冲击前水平(P<0.05);ESWL后即刻尿β2-MG值迅速达高峰(P<0.05),24h降至ESWL前水平(P>0.05)。结论ESWL导致肾结石患者血浆NO水平显著升高,NO可能在肾小管上皮细胞功能恢复中发挥了一定的作用。

Objective To explore the effect of Shock Wave Lithotripsy （SWL） on plasma nitric oxide （NO） and its possible mechanisms. Methods Thirty patients with renal calculus who underwent the initial ESWL treatment and fulfilled the following criteria were included：23 to 65 years old （mean age 41.8 years）,with pelvis or caliceal stones of less than 2 cm,creafinine level less than 133 μmol/L,without evidence of obstruction on excretory urogram, without auxiliary measures before or after ESWL, without application of contrast medium during ESWL,without contraindication against the materials and without anesthesia. These patients received no medication. All the patients received 2 000 shock waves during 30 to 45 minutes in MZ-V lithotripter with an electromagnetic waves generator at 16 KV. Pre- and post-ESWL plasma NO, urinary NAG,γ-GT and β2-MG were measured. Results After shock, there was a significant increase in post plasma NO, with two peaks at the time points of 24 h and one week after the shock（P 〈 0.05）. Urinary enzymes （NAG and γ-GT） and β2-MG significantly increased immediately after ESWL and reached the peak 24 hours later （P 〈 0.05 ）. Urinary γ-GT decreased to the pre-levels in one week while β2-MG 72 hours later（P 〉 0.05）. Urinary NAG activity stayed in higher level for more than one week（P 〈 0.05）. Conclusion Extracorporeal shock wave lithotripsy may induce increase of plasma NO levels ,which might be related to renal tubular injury.