不同能量和频率ESWL治疗肾结石的疗效及肾组织损伤的临床研究

Value of urinary NAG,γ-GT and serum Cys C in patients with renal calculus after ESWL of different energy and frequency

目的:观察不同能量、频率体外冲击波碎石(ESWL)对肾结石患者的疗效,以及手术前后尿N-乙酰-β-D氨基葡萄糖苷酶(NAG)、γ-谷氨酰胺转移酶(γ-GT)和血清胱抑素C(Cys C)的变化及其临床意义。方法:选择2015年3月~2017年3月我院泌尿外科收治的160例肾结石患者和30例健康体检者(对照组)。160例肾结石患者随机分为两组,每组各80例,分别接受低能低频ESWL(低能低频组)和高能高频ESWL(高能高频组)。检测肾结石患者ESWL术前1周、术后1d、术后1周、术后1个月以及对照组尿液中NAG、γ-GT和血清Cys C的含量。结果:160例患者经ESWL治疗后,有效102例(63.75%),无效58例(36.25%)。低能低频组术后1个月结石排净者34例,结石缩小19例,结石残留27例,有效53例(66.25%);高能高频组术后1个月结石排净者32例,结石缩小17例,结石残留31例,有效49例(61.25%)。与对照组比较,肾结石患者ESWL术前尿NAG、γ-GT、血清Cys C含量显著升高(P<0.05)。与术前相比,术后1d肾结石患者尿NAG、γ-GT、血清Cys C含量升高,但差异无统计学意义;与术前1周比较,术后1d肾结石患者尿NAG、γ-GT、血清Cys C含量升高,但差异无统计学意义;术后1周、术后1个月肾结石患者尿NAG、γ-GT、血清Cys C含量显著降低(P<0.05)。术后1d、术后1周,高能高频组较低能低频组尿NAG、γ-GT、血清Cys C含量显著偏高(P<0.05);术后1个月,高能高频组较低能低频组尿NAG、γ-GT含量显著偏高(P<0.05),血清Cys C含量差异无统计学意义。高能高频组、低能低频组术后1周与术后1个月各指标比较,差异无统计学意义。结论:低能低频ESWL与高能高频ESWL治疗肾结石疗效相当,但前者对肾组织损伤更小。尿NAG、γ-GT和血清Cys C可作为ESWL术后评价肾功能变化的敏感指标,具有临床指导意义。

Objective：To determine efficacy of extracorporeal shock wave lithotripsy（ESWL）and the changes and clinical significance of urinary N-acetyl-β-D-glucosaminidase（NAG）,γ-glutamyltransferase（γ-GT）and serum Cystatin C（Cys C）in patients with renal calculus after ESWL.Method：One hundred and sixty cases diagnosed with renal calculus and thirty cases of healthy volunteers were enrolled in this study.All the patients were divided into two groups which received high energy,high frequency ESWL（n=80）and low energy,low frequency ESWL（n=80）,respectively.Urinary NAG,γ-GT and serum Cys C levels of patients at a week before ESWL,the day after ESWL,a week after ESWL and a month after ESWL were measured,as well as the levels of healthy volunteers.Result：After operation,the total effective rate was 63.75%,and ineffective rate was 36.25%.The total effective rate of high energy and high frequency ESWL group was 61.25%,and that of low energy and low frequency ESWL group was 66.25%.Compared to healthy volunteers,expressions of NAG,γ-GT and serum Cys C in patients before ESWL were significantly higher（P0.05）.Compared to preoperation,expressions of NAG,γ-GT and serum Cys C in patients increased at the day after operation,without significant difference.Compared to low energy and low frequency ESWL group,expressions of NAG,γ-GT and Cys C in high energy and high frequency ESWL group increased significantly（P0.05）.Compared to preoperation,expressions of NAG,γ-GT and serum Cys C in patients at a week after operation and a month after operation significantly decreased（P0.05）.Compared to low energy and low frequency ESWL group,expressions of NAG andγ-GT in high energy and high frequency ESWL group down-regulated significantly（P0.05）,and no significance was found in expressions of serum Cys C.The expression of Urinary NAG,γ-GT and serum Cys C between at a week after operation and a month after operation showed no significance.Conclusion：The efficacy of low energy and frequency ESWL is similar to that of high energy and frequency ESWL in treating renal calculus,but low energy and frequency ESWL produces less trauma in kidney tissue.The urinary NAG,γ-GT and serum Cys C are sensitive in evaluating renal function variations and of great value in clinical practice.