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目的:探讨不同灌注压下上尿路腔内碎石术后肾损伤患者尿液肾损伤分子-1(KIM-1)、血清半胱氨酸蛋白酶抑制剂(Cys-C)和降钙素原(PCT)的变化。方法:选取本院收治的行微创经皮肾镜碎石术(MPCNL)、输尿管镜碎石治疗的128例上尿路结石患者作为研究对象,采用酶联免疫吸附双抗体夹心法(ELISA)分别测定患者术前2小时和术后2、12、24、48、72小时的尿液KIM-1和血清Cys-C水平,采用电化学发光法检测患者术前2小时和术后2、4、6、12小时的血清PCT浓度。以术中灌注压力≥13.33kPa为高压组,<13.33kPa为低压组,分析两组患者术前和术后KIM-1、Cys-C和PCT水平的变化及其与灌注压的相关性。结果:两组患者术前2小时和术后2小时的KIM-1和Cys-C水平差异无统计学意义(P>0.05)。两组患者术后12、24、48和72小时各时间点的KIM-1和Cys-C水平均显著高于术前,术后12、24、48和72小时各时间点高压组患者的KIM-1和Cys-C水平均显著高于低压组(P<0.05)。术后4、6和12小时各时间点高压组患者的血清PCT水平均显著高于低压组。KIM-1、Cys-C和PCT水平均与灌注压存在显著正相关关系(r=0.628,0.592,0.571,P<0.01)。结论:肾损伤指标KIM-1和Cys-C、感染指标PCT均与灌注压密切相关;在确保手术疗效的情况下,最高灌注压为13.33kPa,能降低肾损伤和感染的发生。
Objective: To investigate the changes of urinary renal injury molecule-1 (KIM-1), serum cysteine proteinase inhibitor (Cys-C) and procalcitonin (PCT) changes. Methods: A total of 128 patients with upper urinary tract stones underwent minimally invasive percutaneous nephrolithotomy (MPCNL) and ureteroscopic lithotripsy were enrolled in this study. Enzyme-linked immunosorbent assay (ELISA) The levels of KIM-1 and Cys-C in urine were measured at 2 hours and 2,12,24,48 and 72 hours before operation and 2 hours preoperatively and 2 and 4 hours after operation respectively , 6,12 hours of serum PCT concentration. The intraoperative perfusion pressure ≥13.33kPa for the high pressure group, <13.33kPa for the low pressure group, analysis of two groups of patients before and after surgery KIM-1, Cys-C and PCT levels and its correlation with perfusion pressure changes. Results: There was no significant difference in KIM-1 and Cys-C levels between the two groups before operation and two hours after operation (P> 0.05). The KIM-1 and Cys-C levels at 12, 24, 48 and 72 hours after operation in both groups were significantly higher than those in patients in the high-pressure group before operation, at 12, 24, 48 and 72 hours after operation -1 and Cys-C levels were significantly higher than the low-pressure group (P <0.05). At 4, 6 and 12 hours after operation, the serum PCT levels in high-pressure group were significantly higher than those in low-pressure group. KIM-1, Cys-C and PCT levels were positively correlated with perfusion pressure (r = 0.628, 0.592, 0.571, P <0.01). CONCLUSION: The indexes of renal injury KIM-1 and Cys-C and infection index PCT are closely related to perfusion pressure. The maximum perfusion pressure is 13.33 kPa, which can reduce the incidence of renal injury and infection.