术前应用左卡尼汀对腹腔镜下肾部分切除术患者残余肾缺血再灌注损伤的保护作用

Protective effect of preoperative levocarnitine on residual renal ischemia reperfusion injury in patients undergoing laparoscopic partial nephrectomy

目的探讨术前应用左卡尼汀对腹腔镜下肾部分切除术患者残余肾缺血再灌注损伤的保护作用。方法选取2015年7月至2017年8月本院收治的89例经病理检查确诊的肾肿瘤患者,随机数字表法分为空白对照组(术前给予等量0.9%氯化钠溶液,29例)、对照组(术前给予前列地尔注射液,30例)和观察组(术前给予左卡尼汀,30例),比较手术前后三组的超氧化物歧化酶(SOD)、丙二醛(MDA)、核因子E2相关因子2(Nrf2)、血红素氧化酶-1(HO-1)、肾功能[血肌酐(Scr)、血尿素氮(BUN)、肾小球滤过率(eGFR)]及不良反应。结果治疗前三组SOD、MDA、Nrf2、HO-1、Scr、BUN和eGFR比较,差异无统计学意义(P>0.05);与治疗前比较,治疗后观察组SOD降低、MDA升高(P<0.05),Nrf2、HO-1升高(P<0.05),治疗后空白对照组、对照组Scr、BUN增加(P<0.05),eGFR下降(P<0.05),且治疗后观察组的SOD、Nrf2、HO-1、eGFR较空白对照组、对照组均升高(P<0.05),观察组的MDA、Scr、BUN较空白对照组、对照组降低(P<0.05);三组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论术前左卡尼汀应用于腹腔镜下肾部分切除术患者中,其可通过激活机体Nrf2/HO-1通路从而有效减轻患者氧化应激反应,继而有效保护残余肾缺血再灌注损伤。

Objective To investigate the protective effect of preoperative Levocarnitine on re-sidual renal ischemia reperfusion injury in patients undergoing laparoscopic partial nephrectomy.Meth-ods From July 2015 to August 2017,89 patients confirmed by pathologicalexamination with renal neo-plasms were divided into the blank control group(give an equal amount of 0.9%sodium chloride solu-tion before surgery,29 cases),the control group(given alprostadil injection before surgery,30 cases)and the observation group(treated with levocaritine before surgery,30 cases)by random number table method.Superoxide dismutase(SOD),malondialdehyde(MDA),nuclear factor E2 related factor 2(Nrf2),heme oxygenase-1(H0-1),renal function[serum creatinine(Ser),blood urea nitrogen(BUN),estimated glomerulus filtration rate(eGFR)]and adverse reactions before and after surgery were compared among the three groups.Results There was no significant differences in SOD,MDA,Nrf2,HO-1,Scr,BUN or eGFR in the three groups before treatment.SOD decreased in the observation group after treatment,while MDA increased.Nrf2,HO-1 in the observation group increased.Scr and BUN in the blank control group and control group increased,while eGFR decreased(P<0.05).The SOD,Nrf2,H0-1 and eGFR in the observation group were increased compared with the blank control group and control group,while MDA,Scr and BUN were decreased compared with the blank control group and the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions among the three groups.Conclusions Preoperative application of ievocarnitine in patients undergoing laparoscopic partial nephrectomy can effectively reduce the oxidative stress response of patients by activating the NH2/HO-1 pathway,thus effectively protecting residual renal ischemia reperlusion injury.