目的:探究输尿管软镜联合经皮肾镜对肾结石患者炎症免疫指标及相关因子水平的影响。方法:选取我院泌尿外科收治的97例肾结石患者,依据治疗方法分为对照组48例与观察组49例,对照组实施经皮肾镜碎石取石术进行治疗,观察组在对照组治疗基础上,联合输尿管软镜碎石取石术进行治疗。对比2组治疗前后炎症介质、免疫指标、甲状腺素(TH)、尿激酶(UK)、肾功能指标的变化情况。结果:治疗后,两组前列腺素E₂(PGE₂)、P物质(SP)、一氧化氮(NO)、过氧化脂(LPO)水平显著高于治疗前(P<0.05),且对照组PGE₂、SP、NO、LPO水平显著高于观察组(P＜0.05)；两组CD4⁺、CD4⁺/CD8⁺水平显著低于治疗前(P<0.05),而CD8⁺水平显著高于治疗前(P<0.05),且对照组CD4⁺、CD4⁺/CD8⁺水平显著低于观察组(P＜0.05),CD8⁺水平显著高于观察组(P<0.05)；两组TH水平较治疗前显著降低(P<0.05),而UK水平较治疗前显著增高(P<0.05),且观察组TH水平显著低于对照组(P＜0.05),UK水平显著高于对照组(P<0.05)；两组尿素氮(BUN)、血肌酐(Scr)、胱抑素C(CysC)水平显著高于治疗前(P<0.05),且对照组BUN、Scr、CysC水平显著高于观察组(P＜0.05)。结论:联合输尿管软镜与经皮肾镜治疗肾结石,可减轻患者炎症应激反应,缓解免疫抑制现象,增强结石清除能力及降低对肾功能的损伤,具有临床推广意义。

Objective:To explore the effects of flexible ureteroscopy combined with percutaneous nephrolithotomy on inflammatory immune indexes and related factors in patients with renal calculi. Methods: From December 2016 to November 2017. A total of 97 patients with renal calculi were selected and divided into control group (48 cases) and observation group (49 cases), the control group was treated with percutaneous nephrolithotomy. On the basis of the treatment of the control group, the observation group was treated with ureteroscopic lithotripsy. The changes of inflammatory mediators, immune index, thyroxine (TH), urokinase (UK) and renal function were compared between the two groups before and after treatment. Results: After treatment, the levels of prostaglandin E₂ (PGE₂), substance P (SP), nitric oxide (NO) and lipid peroxide (LPO) in the two groups were significantly higher than those before treatment (P<0.05), and the levels of PGE₂, SP, NO and LPO in the control group were significantly higher than those in the observation group (P<0.05); the levels of CD4⁺, CD4⁺/CD8⁺ in the two groups were significantly lower than those before treatment (P<0.05), but the levels of CD8⁺ were significantly higher than those before treatment (P<0.05), and the levels of CD4⁺, CD4⁺/CD8⁺ⁱⁿ the control group were significantly lower than those in the observation group (P<0.05), and the levels of CD8⁺ were significantly higher than those in the observation group (P<0.05); the levels of TH in the two groups were significantly lower than those before treatment (P<0.05), but the levels of UK were significantly higher than those before treatment (P<0.05), and the levels of TH in the observation group were significantly lower than those in the control group (P<0.05), and the levels of UK were significantly higher than those in the control group (P<0.05); the levels of urea nitrogen (BUN), serum creatinine (Scr), cystatin C (CysC) in the two groups were significantly higher than those before treatment (P<0.05), and the levels of BUN, Scr, CysC in the control group were significantly higher than those in the observation group (P<0.05). Conclusions: The combination of ureteroscope and percutaneous nephroscope can relieve inflammation stress, alleviate immunosuppression, enhance stone clearance and reduce the damage to renal function. It is of clinical significance.

R699.2

广东省科技计划项目(2017ZC0113)