尿液CysC、IL-18、KIM-1在钬激光碎石术后早期肾功能损伤的诊断价值

Diagnostic value of urinary CysC,IL-18 and KIM-1 in early renal function injury after holmium laser lithotripsy

目的探讨尿液中胱抑素C(Cys C)、白细胞介素18(IL-18)、肾损伤分子-1(kidney injury molecule-1,KIM-1)在输尿管镜钬激光碎石术前后变化,评估术后早期肾功能损伤。方法选取2019年10月至2021年3月收治的符合条件的单侧输尿管上段结石患者91例作为试验组,其中男51例,女40例,收集碎石术前2 h、术后2 h、6 h、12 h、24 h的尿液标本,应用酶联免疫吸附实验(enzyme-linked immunosorbent assays,ELISA)检测尿液中的CysC、IL-18、KIM-1的浓度变化及其与手术时间、泵的压力的相关性;选择20例同期健康体检者为对照组,检测尿液中该三项指标浓度进行比较。结果试验组患者术前2 h尿CysC、IL-18、KIM-1水平与健康对照组差异无统计学意义(P>0.05);术后2 h、6 h尿CysC、IL-18、KIM-1水平均高于术前2 h和对照组,差异有统计学意义(P<0.05);术后12 h尿CysC、KIM-1水平有所降低,与对照组差异仍有统计学意义(P<0.05);术后12 h尿IL-18水平在各检测时间段最高(P<0.05)。试验组术后24 h尿CysC、IL-18、KIM-1水平接近术前2 h和对照组水平,差异无统计学意义(P>0.05)。术后尿CysC、IL-18、KIM-1的平均水平与手术时间及灌注压力呈正相关(P<0.05)。结论常规输尿管镜钬激光碎石术对肾功能有一定的可逆性损伤,肾脏的代偿作用使受损的肾功能短时间内恢复;联合检测尿液中CysC、IL-18、KIM-1水平变化,对输尿管镜钬激光碎石术后早期肾损害具有一定的诊断价值,为临床监测输尿管镜碎石术后早期肾损害提供参考价值。

Objective To determine the changes in cystatin C(Cys C),interleukin-18(IL-18),and kidney injury molecule-1(KIM-1)urine levels before and after ureteroscopic holmium laser lithotripsy,and to elucidate the effect of ureteroscopic holmium laser lithotripsy on early renal function injuries.Methods A total of 91 eligible patients with unilateral upper ureteral calculi who were admitted from October 2019 to March 2021 were designated as the experimental group,including 51 male and 40 female patients.Urine samples were collected 2 h before lithotripsy,and 2,6,12,and 24 h after lithotripsy.An enzyme-linked adsorption assay(ELISA)was used to determine the concentrations of CysC,IL-18,and KIM-1 in urine and the correlation with operative time and pump pressure.Twenty healthy subjects were designated as the control group and the concentrations of the three urinary indiceswere determined.Results The concentrations of CysC,IL-18,and KIM-1 in the urine samples from the experimental group 2 h preoperatively were not significantly different from the healthy control group(P>0.05).The concentrations of CysC,IL-18 and KIM-1 in the urine samples 2 and 6 h postoperatively were higher than the control group 2 h preoperatively.There were significant differences in the results between the two groups(P<0.05).The concentrations of CysC and KIM-1 in urine samples 12 h postoperatively were significantly lower than the control group(P<0.05).The concentration of IL-18 in urine 12 h postoperatively was the highest value in each group as a function of time,and the results were significantly different(P<0.05).The concentrations of CysC,IL-18,and KIM-1 in urine samples 24 h postoperatively approximated the levels 2 h preoperatively and in the control group,and there was no significant difference(P>0.05).The mean concentrations of CysC,IL-18,and KIM-1 in urine samples postoperalively were positively correlated with the operative time and perfusion pressure(P<0.05).Conclusions Routine ureteroscopic holmium laser lithotripsy was shown to be associated with reversible renal dysfunction.The compensatory property of the kidney can restore renal dysfunction in a short period of time.The combined detection of CysC,IL-18,and KIM-1 concentration changes in urine has diagnostic value for early renal damage after ureteroscopic holmium laser lithotripsy and provides reference values for clinical monitoring of early renal damage after ureteroscopic lithotripsy.