输尿管软镜碎石术中肾盂压力与氧化应激和微炎症相关性研究

目的 探讨输尿管软镜碎石术中肾盂压力变化对患者氧化应激和微炎症的影响。方法 选取2016年12月至2018年1月在本院行输尿管软镜碎石术患者100例的临床资料。术中监测患者肾盂压力,将术中肾盂压力≥30 mmHg,且累计时间≥10 min的患者作为高压组; 其余患者作为低压组,术前和术后第1、3、5、7天再次测定患者尿微量白蛋白、尿β2-微球蛋白水平、血清超敏Ｃ反应蛋白、白介素-6、超氧化物歧化酶、丙二醛、谷胱甘肽水平。结果 术后两组血压和心率变化不明显,差异无统计学意义（P>0．05）,术后两组尿微量白蛋白、尿β2-微球蛋白、血清超敏Ｃ反应蛋白、白介素-6、丙二醛水平明显增加,差异有统计学意义(P<0．05),但高压组增加程度更显著;超氧化物歧化酶和谷胱甘肽明显降低,差异有统计学意义(P<0．05),且高压组降低程度更明显。Pearson相关性分析显示肾盂压力与尿β2-微球蛋白、血清超敏Ｃ反应蛋白、丙二醛呈明显正相关(r=0．716、0．654、0．632,P<0．05),与超氧化物歧化酶和谷胱甘肽呈明显负相关(r=-0．702、-0．711,P<0．05)。结论 输尿管软镜碎石术中肾盂高压导致肾功能损害、引发炎症和氧化还原失衡,术中控制肾盂压力有利于恢复肾功能,避免进一步损伤肾功能。

Correlation between renal pelvic pressure and renal oxidative stress and microinflammation in ureteral lithotripsy

Objective  To investigate the effects of ureteral pressure changes on oxidative stress and microinflammation in patients with ureteral lithotripsy. Methods   From December 2016 to January 2018, 100 patients with renal calculi underwent ureteroscopic lithotripsy were treated in hospital. The ureteral pressure was monitored during operation. The patients with intraoperative ureteral pressure≥40 cmHg and cumulative time≥10 min were used as the high pressure group. The other patients were used as the low pressure group. The urine microalbumin, urinary β2-microglobulin level, serum high-sensitivity C-reactive protein, interleukin-6, superoxide dismutase, malondialdehyde, glutathione level were measured before and at 1, 3, 5, and 7 days after operation. Results   The blood pressure and heart rate of the two groups were not obvious after operation（P>0．05）. The levels of urinary microalbumin, urinary β2-microglobulin, serum high-sensitivity C-reactive protein and interleukin-6 malondialdehyde were significantly increased (P<0．05), but the high-pressure group was increased higher significantly (P<0．05), superoxide dismutase and glutathione were significantly lower (P<0．05), and the high pressure group was more significantly (P<0．05). Pearson correlation analysis showed that renal pelvic pressure was positively correlated with urinary β2-microglobulin, serum high-sensitivity C-reactive protein, and malondialdehyde (r=0．716, 0．654, 0．632, P<0．05), and superoxide dismutase. There was a significant negative correlation with glutathione (r=-0．702, -0．711, P<0．05).Conclusions   In patients with ureteroscopic lithotripsy, renal pelvic hypertension leads to renal dysfunction, inflammation and redox imbalance. Intraoperative control of renal pelvic pressure is beneficial to restore renal function and avoid further damage to renal function.