2018两种取石术治疗肾结石对患者血清NGAL，Cys—C及尿KIM—1水平的影

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【摘要】 目的：探讨输尿管软镜取石术与经皮肾镜取石术两种手术方式治疗肾结石对血清中性粒细胞明胶酶相关脂质运载蛋白（NGAL）、胱抑素C（Cys-C）及尿肾脏损伤分子-1（KIM-1）水平的影响。方法：选取2013年1月-2014年12月本院收治的肾结石患者176例作为研究对象，根据手术方法的不同分为对照组85例和试验组91例，对照组行经皮肾镜取石术，试验组行输尿管软镜取石术，比较两组术前和术后各时间段血清NGAL、Cys-C及尿KIM-1水平的变化情况。结果：试验组血清NGAL和尿KIM-1均于术后12 h达到峰值后逐渐降低，血清Cys-C在术后24 h达到峰值后逐渐降低；对照组血清NGAL在术后12 h达到峰值后逐渐降低，而血清Cys-C及尿KIM-1均于术后24 h达到峰值后逐渐降低。结论：两种手术方式均对肾功能有一定程度的损害，但这些损害是可逆的，输尿管软镜碎石术对肾小球的损害持续时间较长，而经皮肾镜取石术对肾小管损伤的持续时间较长。　　【关键词】 输尿管软镜取石术； 经皮肾镜取石术； 肾结石； 中性粒细胞明胶酶相关脂质运载蛋白； 胱抑素C； 肾脏损伤分子-1　　【Abstract】 Objective：To explore the flexible ureteroscope lithtripsy （FURL） and percutaneous nephrolithotomy （PCNL） two kind of surgery in the treatment of renal calculi with serum neutrophil gelatinase associated lipocalin （NGAL），cystatin C （Cys-C） and urine kidney injury molecule 1 （KIM-1） level effect.Method：From January 2013 to December 2014，176 cases of renal calculi in our hospital were selected as the research objects，they were divided into the control group of 85 cases and the experimental group of 91 cases according to the different surgical methods，the control group was treated with PCNL and the experimental group was treated with FURL，the changes of serum NGAL，Cys-C and urinary KIM-1 levels before and after operation in two groups were compared.Result：The serum levels of NGAL and urine KIM-1 in the experimental group were all decreased gradually after reaching the peak at 12 h after operation，and the serum level of Cys-C decreased gradually after reaching the peak at 24 h after operation.The serum levels of NGAL in the control group was decreased gradually after reaching the peak at 12 h after operation，while the serum levels of Cys-C and urine KIM-1 were gradually decreased after reaching the peak at 24 h after operation.Conclusion：Two kinds of surgical methods have a certain degree of impairment on renal function，but the damage is reversible.The damage of FURL to the glomerular is longer and the damage of PCNL to the renal tubular is longer.　　【Key words】 Flexible ureteroscope lithtripsy； Percutaneous nephrolithotomy； Renal calculi； Neutrophil gelatinase associated lipocalin； Cystatin C； Kidney injury molecule 1　　First-authors address：The Peoples Hospital of Meizhou，Meizhou 514031，China　　doi：10.3969/j.issn.1674-4985.2016.15.018　　肾结石是临床工作中泌尿系统的常见病，常发生于青壮年，男性发病多于女性，左右侧的发病率无显著差异[1]。肾结石发病多数位于肾盂肾盏内，肾实质结石较少见[2]。肾结石的形成过程是由某些因素引起尿中晶体物质浓度升高而溶解度降低，呈过饱和状态，析出结晶聚集而导致结石形成[3]。40%～75%的肾结石患者有不同程度的腰痛。结石较大时，移动范围小，表现为腰部酸胀不适，或在剧烈运动后感觉隐痛或钝痛；较小结石常可大幅度移动，引发的绞痛常骤然发生腰腹部，呈阵发性刀割样剧烈疼痛。当疼痛不能被药物缓解或结石直径较大时，应考虑采取外科手术治疗[4-5]。本文对输尿管软镜取石术与经皮肾镜取石术两种手术方式治疗肾结石对患者血清NGAL，Cys-C及尿KIM-1水平的影响进行研究，旨在比较两种方法对肾功能的影响，现报道如下。