ESWL和输尿管镜下气压弹道碎石术对输尿管结石患者T细胞亚群和NK细胞的影响

目的:探讨体外冲击波碎石术(ESWL)和输尿管镜下气压弹道碎石术(URS-PL)对输尿管下端结石患者T细胞亚群和自然杀伤细胞(NK细胞)的影响及临床意义。方法:收集本院输尿管下段结石61例,行体外冲击波碎石术31例(ESWL组),行输尿管镜下气压弹道碎石术30例(URS-PL组),两组患者分别于术前1天、术毕30 min、术后1天以及术后4天抽取肘静脉血,通过流式细胞仪检测T细胞亚群和NK细胞。统计并比较分析两组患者T细胞亚群、T细胞增殖活性、NK细胞含量以及杀伤活性。结果:ESWL组术后CD_3~+、CD_4~+ T细胞比例、CD_4/CD_8比值、NK细胞比例和杀伤活性无明显变化;URS-PL组术后1天CD_3~+、CD_4~+T细胞比例、CD_4/CD_8比值、NK细胞比例和杀伤活性明显下降(P0.05),与ESWL组比较差异有统计学意义(P0.05),术后4天恢复正常。ESWL组与URS-PL组患者围手术期T细胞增殖变化比较差异无统计学意义(P0.05)。结论:治疗输尿管下段结石,体外冲击波碎石术相对输尿管镜下气压弹道碎石术对T细胞亚群和NK细胞的抑制更细微。免疫应答反应作为监测机体创伤程度这一因素将对选择ESWL和URS-PL治疗输尿管下段结石具有临床指导价值。

The Effects of ESWL and URS-PL on T Cell Subsets and NK Cells in Patients with Ureteral Calculi

Objective：To investigate the effects on T lymphocyte subsets and natural killer cells between ESWL and URS-PL in the treatment of distal ureteral calculi. Methods：From Jan 2009 to Jul 2009, 61 patients with distal ureteral stone were divided into two groups randomly, 31 patients with extracorporeal shock wave lithotripsy （ESWL group）, and another 30 patients with ureteroscopic pneumatic lithotripsy（URS-PL group）. Blood samples were taken 1 day before operation ,30 minutes after operation and on postoperative day ] ,4 to measure T lymphocyte subsets and natural killer cells（NK cells）. Statistics and comparative analysis of two T cell subsets of patients, T cell proliferation activity, NK cell content and killing activity. Results： In ESWL group , the levels of CD3^＋ .CD4^＋ T lymphocytes. CD4^＋/CD8^＋ ratios and NK cell activity were no significant changes. In group of URS-PL, it had significant descendent trend on postoperative day 1 ,there was significant difference between ESWL group and URS-PL group （P〈0.05）. On postoperative day 4, the levels of all above restored normally in URS-PL group. The activity of proliferation of T lymphocyte had no significant difference in both groups （P〈0.05）. Conclusions：Compared with ureteroscopic pneumatic lithotripsy, extracorporeal shock wave lithotripsy has less effects on T lymphocyte subsets and natural-killer cells in the treatment of distal ureteral calculi. The detection of T lymphocyte subsets and natural killer cells are ciinically valuable on ESWL and URS PL in the treatment of distal ureteral calculi.