枸橼酸氢钾钠对上尿路结石患者ESWL术后CIRF、肾功能的影响

Effects of potassium sodium hydrogen citrate on CIRF and renal function in patients with upper urinary tract calculi after ESWL

目的:探讨枸橼酸氢钾钠对上尿路结石患者ESWL术后CIRF、肾功能的影响。方法:按照随机数字表法将我院2018年9月至2020年2月期间收治的113例上尿路结石体外冲击波碎石术(Extracorporeal shock wave lithotripsy,ESWL)后患者分为两组,对照组56例患者予以常规宣教,嘱患者养成早睡早起的睡眠习惯,养成定时排尿的习惯,不憋尿,不食或少食草酸含量高的食物等措施;观察组57例患者口服枸橼酸氢钾钠治疗(早晨、中午各2.5 g,晚上5 g)。治疗3m后进行临床疗效评估,同时采用CT常规平扫检测临床无意义残留结石(Clinically meaningless residual stones,CIRF)发展状况,并统计术后残石相关肾绞痛发生率;以酶联免疫吸附法检测肾功能指标血肌酐(Serum creatinine,Scr)、半胱氨酸蛋白酶抑制剂C(Cysteine protease inhibitor c,Cys-C)、肾小球滤过率(Glomerular filtration rate,GFR)以及中性粒细胞明胶酶相关载脂蛋白(Neutrophil gelatinase-associated apolipoprotein,NGAL)水平;随访1 y后统计两组患者结石复发率。结果:治疗后,观察组总有效率明显高于对照组(P<0.05),CIRF发展状况优于对照组,术后残石相关肾绞痛发生率低于对照组(P<0.05);同时观察组Scr、Cys-C高于对照组,GFR以及NGAL水平低于对照组(P<0.05);观察组结石总复发率明显低于对照组(P<0.05)。结论:对上尿路结石患者ESWL术后患者予以枸橼酸氢钾钠,可改善肾功能,调节CIRF指标,降低后残石相关肾绞痛发生率和复发率,提高治疗效果。

Objective:To investigate the effect of potassium sodium hydrogen citrate on CIRF and renal function in patients with upper urinary tract calculi after ESWL.Methods:113 patients with upper urinary tract calculi treated in our hospital from September 2018 to February 2020 after extracorporeal shock wave lithotripsy(ESWL)were divided into two groups according to the random number table method.56 patients in the control group were given routine education,and the patients were instructed to develop the sleep habit of going to bed and getting up early,develop the habit of regular urination and do not hold urine,do not eat or eat less food with high oxalic acid content;57 patients in the observation group were treated with oral potassium sodium citrate(2.5 g in the morning,2.5 g at noon and 5 g in the evening).The clinical efficacy was evaluated 3 m after treatment.At the same time,the development of clinically meaningless residual stones(CIRF)was detected by conventional plain CT scan,and the incidence of postoperative residual stone related renal colic was counted;The indexes of renal function were detected by enzyme-linked immunosorbent assay;After the follow-up,the stone recurrence rate of the two groups was counted.Results:after treatment,the total effective rate of the observation group was significantly higher than that of the control group(P<0.05),the development of CIRF was better than that of the control group,and the incidence of postoperative residual stone related renal colic was lower than that of the control group(P<0.05);At the same time,the levels of serum creatinine(SCR)and cysteine protease inhibitor C(Cys-C)in the observation group were higher than those in the control group,and the levels of glomerular filtration rate(GFR)and neutrophil gelatinase associated apolipoprotein(NGAL)in the observation group were lower than those in the control group(P<0.05);The total recurrence rate of stones in the observation group was significantly lower than that in the control group(P<0.05).Conclusion:potassium sodium hydrogen citrate can improve renal function,regulate CIRF index,reduce the incidence and recurrence rate of renal colic associated with posterior residual stone,and improve the therapeutic effect.