摘要
目的观察肾结石患者输尿管软镜碎石手术前、后血清皮质醇、促肾上腺皮质激素(adrenocorticotropic hormone, ACTH)水平及术后早期肾损伤发生情况,分析血清皮质醇、ACTH水平与术后早期肾损伤的关系。方法肾结石患者93例,均行输尿管软镜碎石术治疗,根据术后早期(术后48 h内)是否发生肾损伤分为肾损伤组52例和无肾损伤组41例。术前2 h及术后6、12、24、48 h,采用放射免疫法检测患者血清皮质醇、ACTH水平,采用肌氨酸氧化法检测血肌酐水平,并进行2组间比较;采用双变量Pearson直线相关性分析血清皮质醇、ACTH水平与肾结石患者输尿管软镜碎石术后早期肾损伤的相关性;绘制ROC曲线,评估术后12、24 h血清皮质醇、ACTH水平对术后早期肾损伤发生的预测效能。结果 2组术前及术后6、48 h血清皮质醇、ACTH水平比较差异无统计学意义(P>0.05),术后6、12、24、48 h血清皮质醇、ACTH水平均高于术前(P<0.05),肾损伤组术后12、24 h血清皮质醇[(138.54±20.15)、(158.64±22.15)μg/L]、ACTH[(35.68±6.15)、(46.58±7.25)ng/L]水平高于无肾损伤组[(120.64±17.52)、(141.30±18.65)μg/L,(26.35±5.12)、(38.25±6.12)ng/L](P<0.05);2组术前、术后6 h血肌酐水平比较差异无统计学意义(P>0.05),肾损伤组术后12、24、48 h血肌酐水平[(72.25±21.34)、(77.58±25.64)、(98.68±28.64)μmol/L]高于无肾损伤组[(62.02±18.05)、(59.64±20.36)、(55.36±24.16)μmol/L](P<0.05)。术后早期肾损伤患者术后12 h血清皮质醇、ACTH水平与血肌酐呈正相关(r=0.856,P<0.001;r=0.703,P<0.001),血清皮质醇与ACTH水平呈正相关(r=0.752,P<0.001)。术后12 h血清皮质醇、ACTH最佳截断值分别为132.20μg/L、33.30 ng/L时,预测输尿管软镜碎石术后早期肾损伤发生的AUC分别为0.853(95%CI:0.777~0.929,P<0.001)、0.845(95%CI:0.764~0.925,P<0.001);术后24 h血清皮质醇、ACTH最佳截断值分别为148.58μg/L、35.58 ng/L时,预测早期肾损伤发生的AUC�
Objective To observe the levels of serum cortisol(COR) and adrenocorticotropic hormone(ACTH) in patients with renal calculus before and after flexible ureteroscopic lithotripsy and the occurrence of early renal injury after operation, and to analyze the relationships of serum COR and ACTH with early postoperative renal injury. Methods Ninety-three patients with renal calculus underwent flexible ureteroscopic lithotripsy. According to whether renal injury occurred in the early stage after operation(within 48 h), 93 patients were divided into renal injury group(n=52) and non-renal injury group(n=41). Two hours before, and 6, 12, 24 and 48 h after operation, the serum levels of COR and ACTH were detected by radioimmunoassay, and the serum creatinine(SCr) level was measured by creatine oxidation method, which were compared between two groups. Bivariate Pearson linear correlation test was used to analyze the correlations of serum COR and ACTH levels with early renal injury after flexible ureteroscopic lithotripsy.ROC was drawn to assess the values of serum COR and ACTH 12 and 24 hafter operation to the prediction of early postoperative renal injury.Results The levels of serum COR and ACTH showed no significant differences between two groups before operation as well as 6 and 48 hafter operation(P>0.05),and were higher 6,12,24 and 48 hafter operation than those before operation(P<0.05).The serum levels of COR((138.54±20.15),(158.64±22.15)μg/L)and ACTH((35.68±6.15),(46.58±7.25)ng/L)12 and 24 hafter operation in renal injury group were higher than those in non-renal injury group((120.64±17.52),(141.30±18.65)μg/L;(26.35±5.12),(38.25±6.12)ng/L)(P<0.05).The level of SCr showed no significant difference before and 6 hafter operation(P>0.05).The SCr levels 12,24 and48 hafter operation were higher in renal injury group((72.25±21.34),(77.58±25.64),(98.68±28.64)μmol/L)than those in non-renal injury group((62.02±18.05),(59.64±20.36),(55.36±24.16)μmol/L)(P<0.05).The serum levels of COR and ACTH were positively cor
作者
艾合买提·艾买尔
雷鹏
塔来提·塔依尔
张小安
亚力坤·阿里木
文彬
阿不力孜·司马义
Aihemaiti AIMAIER;LEI Peng;Talaiti TAYIER;ZHANG Xiao-an;Yalikun ALIMU;WEN Bin;Abulizi SIMAYI(Urology Center Calculus Ward,People's Hospital of Xinjiang Uygur Autonomous Region,Urumqi,Xinjiang Uygur Autonomous Region 830001,China)
出处
《中华实用诊断与治疗杂志》
2021年第2期151-155,共5页
Journal of Chinese Practical Diagnosis and Therapy
基金
新疆维吾尔自治区自然科学基金(2018D01C309)。
