滋肾化石汤辅助双镜联合术治疗复杂性肾结石的疗效及对红细胞免疫功能的影响

The therapeutic efficacy of Zishen Huashi Decoction in complex renal calculi and its effects on the immune function of erythrocytes

目的评价滋肾化石汤辅助双镜联合术治疗复杂性肾结石的疗效及对患者红细胞免疫功能的影响。方法该研究为前瞻性随机对照试验,选取2018年10月—2021年4月就诊于唐山市工人医院的108例复杂性肾结石患者。按随机数表法分组将患者分为对照组和实验组,每组54例。对照组接受经皮肾镜联合输尿管软镜碎石取石术,实验组实施经皮肾镜联合输尿管软镜碎石取石术+滋肾化石汤治疗。对比两组疗效、一期手术结石清除率、肾损伤因子、红细胞免疫功能、炎症应激反应、并发症。结果实验组总有效率、一期手术结石清除率较对照组高(P<0.05)。两组术前血清人肾损伤分子1(KIM-1)、中性粒细胞明胶酶相关载脂蛋白(NGAL)、尿素氮(BUN)及胱抑素C(Cys-C)水平比较,差异无统计学意义(P>0.05),实验组术后7 d血清KIM-1、NGAL、BUN及Cys-C水平较对照组低(P<0.05)。两组术前血清红细胞C3b受体花环率(C3bRR)、免疫复合物受体花环率(ICRRR)、肿瘤红细胞花环率(TER)及红细胞免疫复合物花环率(RBC-ICR)水平比较,差异无统计学意义(P>0.05),实验组术后7 d血清C3bRR、ICRRR、TER及RBC-ICR水平较对照组高(P<0.05)。两组术前血清白细胞介素-1β(IL-1β)、高敏C反应蛋白(hs-CRP)、血管紧张素Ⅰ(AngⅠ)及血管紧张素Ⅱ(AngⅡ)水平比较,差异无统计学意义(P>0.05)。实验组术后7 d血清血清IL-1β、hs-CRP、AngⅠ及AngⅡ水平较对照组低(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。结论复杂性肾结石患者接受滋肾化石汤辅助双镜联合术的效果确切,可提升一期手术结石清除率,减轻肾损伤,改善红细胞免疫功能,降低炎性应激反应。

Objective To evaluate the efficacy of Zishen Huashi Decoction as an adjuvant therapy for complex renal calculi treated with percutaneous nephrostolithotomy combined with flexible ureteroscopy,and to explore the effects of Zishen Huashi Decoction on the immune function of erythrocytes.Methods This prospective randomized controlled trial included 108 patients with complex renal calculi who were admitted to Tangshan Workers'Hospital from October 2018 to April 2021 and were grouped according to the random number table.The control group(54 cases)received percutaneous nephrostolithotomy combined with flexible ureteroscopy,while the experimental group(54 cases)also received Zishen Huashi Decoction treatment in addition to percutaneous nephrostolithotomy combined with flexible ureteroscopy.The curative effect,the proportion of one-stage operation,indicators for kidney injury,immune function of erythrocytes,inflammatory response,and complications were compared between the two groups.Results The overall effective rate and the proportion of one-stage operation were higher in the experimental group than those in the control group(P<0.05).There was no difference in serum levels of kidney injury molecule-1(KIM-1),neutrophil gelatinase-associated lipocalin(NGAL),blood urea nitrogen(BUN)and cystatin C(Cys-C)between the two groups preoperatively(P>0.05),while the levels of these indicators were lower in the experimental group 7 days following the operation(P<0.05).The serum levels of C3bRR,ICRRR,TER,and RBC-ICR were not different between the groups before the operation(P>0.05),but were higher in the experimental group 7 days after the operation(P<0.05).In addition,the serum levels of interleukin(IL)-1β,high-sensitivity C-reactive protein(hs-CRP),angiotensin(Ang)Ⅰand AngⅡwere also not different between the groups before the operation(P>0.05),yet they were lower in the experimental group compared with the control group postoperatively(P<0.05).No difference was observed in the incidence of postoperative complications between the groups(P>0.05).Conclusions The Zishen Huashi Decoction is effective as an adjuvant treatment for complex renal calculi treated with percutaneous nephrostolithotomy combined with flexible ureteroscopy,by increasing the proportion of one-stage operation,reducing kidney injury,improving the immune function of erythrocytes,and ameliorating the inflammatory response.