不同焦斑与能量冲击波碎石机治疗肾结石的疗效及对早期肾功能影响的随机对照研究

Comparison the efficacy and safety of lithotriptors with different focus size and energy in the management of renal calculi

目的比较宽焦斑高能量与传统窄焦斑低能量体外冲击波碎石(SWL)治疗肾结石的疗效及安全性。方法将接受SWL治疗的肾结石患者分为两组,A组用宽焦斑高能量碎石机,B组用窄焦斑低能量碎石机。SWL前后分别检测尿嗜中性粒细胞明胶酶相关载脂蛋白(NGAL)和α1微球蛋白(α1-MG)。结果两组各60例入选,1个月结石排净率及并发症率差异均无显著性。结石>10 mm者,A组的复震率较低(11.1%vs 39.1%,P=0.021),但并发症率(25.9%vs 4.3%,P=0.038)较高。A组NGAL升高幅度显著高于B组(P<0.001)。结论宽焦斑高能量与窄焦斑低能量SWL均是肾结石的有效安全的治疗方法,对于10 mm以上的肾结石,前者带给结石更多的能量同时也造成了更多的一过性损伤。NGAL对评价SWL引起早期肾损伤有潜在作用。

Objective To compare the clinical efficacy and safety of wide-focus high energy lithotriptor with narrow-focus low energy lithotriptor treating renal calculi. Methods A prospective study was conducted to compare both modalities for the management of renal calculi. Stone formers were randomly enrolled into two groups. Group A was managed with wide-focus high energy lithotriptor, while group B was managed with the other. Urine samples were collected to detect neutrophil gelatinase-associated lipocalin （NGAL） and ct 1-microglobulin （a 1- MG） levels before and after SWL. Results 60 were randomized to the group A and 60 to group B. There was no significant difference between two groups in stone free rate and complication rate. For stones more than 10 mm, re- treat rate（ 11.1% vs 39.1% ,P -- 0.021 ） was lower and complication rate （25.9% vs 4.3% ,P = 0.038） was higher in group A. There had a larger increase of NGAL in group A （P 〈 0.001 ） after SWL. Conclusion SWL with both lithotriptors are effective and safe for renal stones. Wide-focus high energy lithotripsy was assoeiated with lower retreat rate and higher complication rate for stones more than 10 ram. NGAL may play a potential role in the evaluation of SWL indueed early renal injury.