摘要目的 通过测定肾功能受损指标血中性粒细胞明胶酶相关脂质运载蛋白( neutrophil gelatinase-associated lipocalin,NGAL)、半胱氨酸蛋白酶抑制剂 C(cystatin C,Cys-C)的变化,探讨输尿管软镜钬激光碎石术治疗肾结石对肾功能的影响. 方法 选取2010年10月至2012年3月41例单发肾结石患者进行输尿管软镜钬激光碎石术,男24例,女17例.年龄31 ～ 76岁,平均(51.9±15.9)岁、.术前经KUB、CT或超声检查确诊为单侧肾结石,其中左肾结石25例,右肾结石16例.结石位于肾中、上盏22例,下盏9例,肾盂10例.结石直径10 ～ 28 mm,平均(16.9±6.0)mm.患者术前2h血NGAL、Cys-C测定值分别为(3.5±0.6)、(501.7±121.3) μg/L,将其作为基线值.测定术后2、12、24、48、72 h血NGAL、Cys-C浓度,观察术后各时间点两种指标浓度的变化. 结果 术后2、12、24、48、72 h血NGAL浓度分别为(4.2±0.8)、(5.0±1.0)、(4.9±1.4)、(4.3±1.1)、(3.8±0.1)μg/L,其浓度在术后2h开始上升,与基线值比较差异有统计学意义(P＜0.05),并在12h达到峰值,随后开始下降,至72 h时仍高于基线值,但差异无统计学意义(P＞0.05);术后2、12、24、48、72 h血Cys-C浓度分别为(516.4 ±126.2)、(723.8±134.8)、(770.4±162.8)、(671.7 ±138.3)、(574.0±116.7) μg/L,其浓度在术后2h时与基线值比较差异无统计学意义(P＞0.05),但于术后12h时明显上升并于术后24 h达峰值,至术后72 h仍高于基线值,差异均有统计学意义(P＜0.05). 结论 输尿管软镜钬激光碎石术治疗肾结石后可导致肾功能损害,表现为肾小球及肾小管均有不同程度的受损,但其损害是可恢复的.

abstractsObjective　To analyze the effects of flexible ureteroscopic Holmium laser lithotripsy on renal function in the treatmen of renal calculi.　Methods　From October 2010 to March 2012,41 cases of solitary renal calculi (24 males and 17 females) were treated with flexible ureteroscopic Holmium laser lithotripsy ( FURL).Patient's mean age was 51.9 ± 15.9 years ( range from 31 to 88 years).Locations of renal calculi detected by image study were 22 cases in middle and upper calyx,9 cases in lower calyx,10 case in renal pelvis.The mean size of calculi was 16.9 ±6.0 mm (range from 10 to 28 mm).Blood samples (2 h pre-operatively,and then 2 h,12 h,24 h,48 h,72 h post-operatively) were collected and serum　NGAL,serum Cys-C were tested　Results　The measured levels of pre-operative NGAL and Cys-C were 3.5 ± 0.6μg/L,501.7±121.3 μg/L,and levels of post-operative NGAL at 2 h,12 h,24 h,48 h and 72 h were 4.2±0.8 μg/L,5.0±1.0 μg/L,4.9±1.4 μg/L,4.3± 1.1 μg/L and 3.8 ±0.1 μg/L,while the according levels of Cys-C were ( 516.4 ± 126.2 ) μg/L,( 723.8 ± 134.8 ) μg/L,( 770.4 ± 162.8 ) μg/L,(671.7 ± 138.3 ) μg/L and 574.0 ± 116.7 μg/L.Serum NGAL began to increase 2 hours after operation (P ＜0.05,and reached the peak in 12 hours,it began to decline 12 hours after surgery,but it was still higher at 72 hours than pre-operative level (P ＜ 0.05.Serum Cys-C showed no obvious ascent 2 hours after operation in FURL group ( P ＞ 0.05 ),but increased obviously 12 hours after operation and lowered down after the peak that occurred 24 hours after surgery.Serum Cys-C still remain above the baseline 72 hours after operation (P ＜0.05).　Conclusions　Flexible ureteroscope lithotripsy can cause reversible damage to renal function after surgery.