EMT与输尿管结石钬激光碎石后输尿管狭窄的关系研究

目的　探讨分析上皮间质转化（EMT）与输尿管结石钬激光碎石后输尿管狭窄的关系。方法　选取2019年6月至2021年6月河南科技大学第一附属医院行输尿管结石钬激光碎石术后34例出现输尿管狭窄患者作为狭窄组，其中男19例、女15例，年龄（44.54±10.35）岁，按1∶1比例选取同期收治行输尿管钬激光碎石术后未出现输尿管狭窄的34例作为非狭窄组，男20例、女14例，年龄（45.56±9.57）岁。采用χ²检验或独立样本t检验比较两组患者一般资料及血清高迁移率族蛋白B1（HMGB1）、白细胞介素-1β（IL-1β）、转化生长因子-β1（TGF-β1）水平差异，并使用受试者工作特征曲线（ROC）分析血清HMGB1、IL-1β、TGF-β1水平对钬激光碎石术后输尿管狭窄的预测效能。结果　术前，两组患者血清HMGB1、IL-1β、TGF-β1水平比较，差异均无统计学意义（均P>0.05）；术后第7天，狭窄组患者血清HMGB1、IL-1β、TGF-β1水平分别为（15.98±1.11）μg/L、（24.23±1.54）μg/L、（381.58±38.52）ng/L，均高于非狭窄组的（14.21±1.02）μg/L、（23.11±1.08）μg/L、（318.23±27.54）ng/L，差异均有统计学意义（均P<0.05）。ROC分析显示，患者术后第7天血清HMGB1、IL-1β、TGF-β1水平均可作为钬激光碎石术后输尿管狭窄的预测指标（Z=7.421、2.759、10.740，均P<0.05），其曲线下面积（AUC）分别为0.848、0.679、0.898，其中血清TGF-β1的预测效能最高。结论　钬激光碎石术引起输尿管损伤可导致血清HMGB1、IL-1β、TGF-β1水平升高，患者血清HMGB1、IL-1β、TGF-β1水平可作为钬激光碎石术后输尿管狭窄的预测指标。

Study on the relationship between EMT and ureteral stricture after holmium laser lithotripsy for ureteral calculi

Objective　To explore the relationship between epithelial-mesenchymal transition (EMT) and ureteral stricture after holmium laser lithotripsy for ureteral calculi. Methods　A total of 34 patients with ureteral stricture after holmium laser lithotripsy for ureteral calculi in The First Affiliated Hospital of Henan University of Science and Technology between June 2019 and June 2021 were selected as the stricture group, including 19 males and 15 females, with an age of (44.54±10.35) years old. Another 34 patients without ureteral stricture after ureteral holmium laser lithotripsy during the same period were regarded as the non-stricture group according to the ratio of 1:1, including 20 males and 14 females, with an age of (45.56±9.57) years old. χ² test or independent sample t test was used to compare the general data and serum levels of high mobility group protein B1 (HMGB1), interleukin-1β (IL-1β), and transforming growth factor-β1 (TGF-β1) between the two groups, and the receiver operating characteristic curve (ROC) was used to analyze the predictive efficacies of serum HMGB1, IL-1β, and TGF-β1 levels in ureteral stricture after holmium laser lithotripsy. Results　Before surgery, there were no statistically significant differences in the serum HMGB1, IL-1β, and TGF-β1 levels between the two groups (all P>0.05); on the postoperative 7th day, the serum levels of HMGB1, IL-1β, and TGF-β1 in the stenosis group were (15.98±1.11) μg/L, (24.23±1.54) μg/L, and (381.58±38.52) ng/L, which were higher than those in the non-stenosis group (14.21±1.02) μg/L, (23.11±1.08) μg/L, and (318.23±27.54) ng/L], with statistically significant differences (all P<0.05). The ROC analysis showed that serum levels of HMGB1, IL-1β, and TGF-β1 on the postoperative 7th day could be used as predictors for ureteral stenosis after holmium laser lithotripsy (Z=7.421, 2.759, and 10.740; all P<0.05), the area under the curve (AUC) was 0.848, 0.679, and 0.898, respectively, and serum TGF-β1 had the highest predictive efficiency. Conclusions　Ureteral injury caused by holmium laser lithotripsy can lead to the increases of serum HMGB1, IL-1β, and TGF-β1 levels. Patients' serum HMGB1, IL-1β, and TGF-β1 levels can be used as predictors for ureteral stricture after holmium laser lithotripsy.