肾结石合并肾功能不全患者围手术期尿微量白蛋白与尿肌酐比值检测及意义

Determination and its significance of the ratio of urine microalbumin to urine cretinine in patients with nephrolithiasis complicated with renal insufficiency

目的:探讨肾结石合并肾功能不全患者经皮肾镜取石手术前后尿微量白蛋白与尿肌酐比值(microalbu-min/urine cretinine,mALB/Ucr)的变化及意义。方法:对实验组21例肾结石合并肾功能不全患者在行标准通道经皮肾镜取石术术前及术后1天、7天、30天、90天分别检测mALB/Ucr和血肌酐(serum cretinine,Scr),同时记录实验组患者手术时间、手术通道数目指标;同样的方法检测对照组27例肾功能正常肾结石患者术前mALB/Ucr和Scr。结果:术前mALB/Ucr实验组高于对照组,且两组间差异有统计学意义(P<0.001);实验组术后7天mALB/Ucr值与术后30天(P=0.546)、90天(P=0.368)相比差异无统计学意义。实验组术后30天Scr值明显低于术后7天(P=0.032),但术后90天Scr值与术后30天相比差异则无统计学意义(P=0.772)。实验组术前与术后7天的mALB/Ucr差值(ΔmALB/Ucr)与手术通道数目呈正相关(r=0.437,P=0.047),而与手术时间无相关性(r=0.333,P=0.140)。术前-术后7天的ΔmALB/Ucr与ΔScr无相关性(r=0.323,P=0.153);术前-术后30天的ΔmALB/Ucr与ΔScr(r=0.632,P=0.002)、术前-术后90天的ΔmALB/Ucr与ΔScr(r=0.476,P=0.029)成正相关。结论:实验组术前肾脏滤过功能损害较对照组严重,实验组mALB/Ucr和Scr分别于术后7天和30天趋于稳定,手术通道增加(最多3个通道)有利于恢复肾脏的滤过功能。通过检测实验组患者ΔmALB/Ucr的数值,可以在患者出院前为患者术后中远期肾功能转归提供较可靠的评估。

Objective：To investigate the significance of change of urine microalbumin/urine cretinine（mALB/Ucr） in nephrolithiasis patients with renal dysfunction（experimental group） before and after percutaneous nephrolithotomy（PCNL）.Methods： mALB/Ucr value and serum cretinine（Scr） value were analyzed in 21 nephrolithiasis patients with renal dysfunction before PCNL,and 1,7,30 and 90 days after PCNL.Operative time and the number of tract were recorded and analyzed in the experimental group.The same work was done in 27 nephrolithiasis patients with normal renal function（control group） before surgery.Results： The levels of mALB/ Ucr in experimental group patients before PCNL were significantly higher than those in control group（P0.001）.The levels of mALB /Ucr between 7 days after operation and 30 days（P=0.054） or 90 days（P=0.062） after operation were not statistically significant.The levels of Scr of 30 days after operation in experimental group were lower than those of 7 days after surgery（P0.001）;But they were not statistically significant compared with those of 90 days after surgery（P =0.106）.The mALB/Ucr difference between before PCNL and 7 days after PCNL（ΔmALB/Ucr） was positively correlated to the number of operation tract（r=0.486,P=0.030）,but it was not correlated to operation time（r=0.323,P=0.129）.The ΔmALB/Ucr was not correlated to Scr difference between before PCNL and 7 days after PCNL（r=0.323,P=0.153）.Actually the ΔmALB/Ucr was correlated to Scr difference between before PCNL and 30 days（r=0.632,P=0.002）,or 90 days（r=0.476,P=0.003） after PCNL.Conclusion： The damage to kidney filtration of experimental group was more severe than that of control group.The mALB/Ucr or Scr level of experimental group trends to be stable in 7 or 30 days after operation.Increasing operation tracts（less than 3 tracts） can help to restore kidney filtration function.A reliable assessment,of a long-term outcome of the patients＇renal function can be reached,by calculating the patients＇ ΔmALB/Ucr in the experimental group.