输尿管软镜取石术对上尿路结石患者血清Treg细胞及CD4^(+)/CD8^(+)T细胞亚群的影响

Effect of flexible ureteroscopic lithotomy on Treg cells and CD4^(+)/CD8^(+)T cell subsets in patients with upper urinary calculi

目的探讨输尿管软镜取石术对上尿路结石患者血清调节性T细胞(Treg细胞)及CD4^(+)/CD8^(+)T细胞亚群的影响。方法选取上尿路结石患者共80例作为研究对象。按治疗方法分为观察组40例和对照组40例。对照组给予经皮肾镜取石术治疗,观察组给予输尿管软镜取石术治疗。比较两组患者手术情况,包括手术时间、住院时间、结石清除率,比较两组患者手术前后肾功能情况及Treg细胞数值,比较两组患者手术前后CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)水平变化,比较两组患者并发症发生率。结果观察组手术时间和住院时间均短于对照组,结石清除率高于对照组(P<0.05)。与术前比较,观察组术后BUN、Scr、β2-MG数值差异无统计学意义,对照组术后BUN、Scr、β2-MG数值均升高,观察组低于对照组(P<0.05)。与术前比较,两组患者CD4^(+)CD25^(+)FOXP3^(+)Tregs数值均降低,观察组低于对照组(P<0.05)。与术前比较,术后对照组CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)均降低,观察组CD4^(+)/CD8^(+)降低,CD8^(+)升高;对照组CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)均低于观察组(P<0.05)。观察组总不良反应发生率低于对照组(P<0.05)。结论输尿管软镜取石术对上尿路结石疗效明显,可保障Treg细胞及CD4^(+)/CD8^(+)T细胞亚群数值及功能,平衡患者机体免疫功能,术后并发症发生率低。

Objective To investigate the effects of flexible ureteroscopic lithotomy on serum regulatory T cells(Treg cells)and CD4^(+)/CD8^(+)T cell subsets in patients with upper urinary calculi.Methods A total of 80 patients with upper urinary calculi were selected as the research objects and were divided into observation group(n=40)and control group(n=40)according to the treatment.The control group was treated with percutaneous nephrolithotomy,and the observation group was treated with flexible ureteroscopic lithotomy.Operation conditions of patients in the two groups were compared,including operation time,hospital stay,stone clearance rate,renal function and Treg cell values before and after surgery,changes in CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)levels before and after surgery,and incidence of complications.Results The operation time and hospital stay in observation group were significantly shorter than those in control group,and the stone clearance rate was significantly higher than that in control group(P<0.05).Compared with pre-operation,there was no significant difference in BUN,Scr orβ2-Mg values in the observation group after operation;but the values of BUN,Scr andβ2-Mg in the control group were all increased after operation;and the observation group was lower than the control group(P<0.05).Compared with pre-operation,CD4^(+)CD25^(+)FOXP3^(+)Tregs in 2 groups were reduced,and that in the observation group was lower than the control group(P<0.05).Compared with before operation,CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)were reduced in the control group after operation,while CD4^(+)/CD8^(+)reduced and CD8^(+)increased in the observation group.CD3^(+),CD4^(+),CD8^(+)and CD4^(+)/CD8^(+)in the control group were lower than those in the observation group(P<0.05).The incidence of total adverse reactions in observation group was significantly lower than that in control group(P<0.05).Conclusion Flexible ureteroscopic lithotomy has obvious efficacy on the treatment of upper urinary calculi,which can guarantee the value and function of Treg cells and CD4^(+)/CD8^(+)T cell subsets,balance the immune function of patients,and reduce the incidence of postoperative complications.