益肾排石中药对体外冲击波碎石致肾损伤保护作用的临床研究

目的 探讨益肾排石中药对肾结石患者体外冲击波碎石（extracorporeal shock wave lithotripsy,ESWL）后肾损伤的保护作用及可能机制。方法 选择60例经X线或CT检查结合腹部B超确诊为肾结石而无明显症状患者，随机分两组，中药组于碎石前至碎石后3天口服益肾排石中药，对照组给予日常饮食，观察两组患者ESWL后血一氧化氮（nitric oxide,NO）、肿瘤坏死因子α（tumor necrosis factor- alpha, TNF-α）、内皮素-1（endothelin-1, ET-1）、超氧化物歧化酶（superoxide dismutase, SOD）、丙二醛（malondialdehyde, MDA）及尿N-乙酰-β-葡萄糖苷酶（N-acetyl-β-Dglucosaminidase, NAG)、γ-谷氨酰胺转肽酶（γ-glutamyltransferase, γ-GT)及尿β2-微球蛋白(β2-microglobulin, β2-MG)的变化。结果 ESWL后对照组血NO、MDA、TNF-α值和ET-1水平显著升高，均高于中药组(P<0.05)。ESWL后对照组血SOD值逐渐下降，ESWL后72 h达低谷值(P<0.05)，中药组ESWL前后差异无统计学意义 (P>0.05)，与对照组比较，差异有统计学意义（P<0.05）。ESWL后对照组尿NAG、γ-GT及尿β2-MG值显著升高，与中药组比较，差异有统计学意义 (P<0.05)。结论 ESWL可引起肾结石患者肾损伤，益肾排石中药可通过抗氧化、调节肾脏血流动力学紊乱及炎性介质释放，减轻肾小管上皮细胞损伤。

The Protective Effect of Chinese Herbs for Supplementing Shen to Eliminate Stone on Renal Injury Induced by Extracorporeal Shockwave Lithotripsy in Patients with Renal Calculus

OBJECTIVE: To study the protective effect of Chinese herbs for supplementing Shen to eliminate stone on renal injury induced by extracorporeal shockwave lithotripsy (ESWL) in patients with renal calculus. METHODS: Sixty patients with diagnosis of renal calculus confirmed by X-ray film or CT combined with abdominal B ultrasonography but showing no obvious symptoms, were randomized into the treated group and the control group. They all were scheduled to receive ESWL treatment. To the patients in the treated group, prescribed Chinese herbs was orally administered in the three days before and after ESWL, patients in the control group ate and drank as usual. Changes of blood levels of nitric oxide (NO), endothelin-1 (ET-1), superoxide dismutase (SOD), malondialdehyde (MDA), tumor necrosis factor alpha (TNF-alpha), urinary levels of N-acetyl-D-glucosaminidase (NAG), gamma-glutamyltransferase (gamma-GT) and beta 2-microglobulin (beta 2-MG) before and after ESWL were observed. RESULTS: Blood levels of NO, ET-1, MDA and TNF-alpha significantly increased after ESWL in the control group, higher than the levels in the treated group (P < 0.05); and level of SOD decreased gradually in the control group reaching the valley 72 h after ESWL (P < 0.05), while in the treated group it was unchanged and remained at the level higher than that in the control group (P < 0.05). As for the urinary levels of NAG, gamma-GT and beta2-MG, after ESWL, they were all higher in the control group than those in the treated group, showing statistical significance (P <0. 05). CONCLUSION: ESWL could induce renal damage in patients with renal calculus and the Chinese herbs for supplementing Shen to eliminate stone can reduce the renal tubular damage by way of anti-oxidation and regulating the renal hemorrheologic disorder and the release of inflammatory mediators.