Study on markers of kidney injury after flexible ureteroscopic lithotripsy in patients with infectious nephrolithiasis
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摘要: 目的 探讨感染性肾结石患者在接受输尿管软镜碎石术后肾损伤标记物的变化，以评估术后肾功能的早期损伤，为临床治疗提供指导。 方法 选取解放军总医院第三医学中心泌尿外科2023年8月—2024年6月收治的174例结石患者，根据术后结石成分分析结果分为对照组与感染性结石组。所有患者均接受输尿管软镜碎石术，术前及术后不同时间点收集尿液样本，采用酶联免疫吸附试验(enzyme linked immunosorbent assay，ELISA)法检测尿液中的肾损伤分子1(kidney injury molecule 1，KIM-1)和中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin，NGAL)。使用统计学软件进行数据分析。 结果 2组患者基线资料比较差异无统计学意义，具有可比性。2组手术相关指标(手术时间、术后住院天数、并发症发生率及结石清除率)比较均差异无统计学意义。术前感染性结石组尿白细胞和尿素氮水平显著高于对照组，术后感染性结石组尿素氮水平仍高于对照组。肾损伤标记物检测结果显示，感染性结石组术后3 h尿液中KIM-1及NGAL水平高于术前及对照组，差异有统计学意义(P＜0.05)。对照组及感染性结石组的尿液肾损伤标记物在术后3 h左右达到最高值，并在之后呈现下降趋势。 结论 输尿管软镜碎石术后，感染性肾结石患者的尿液肾损伤标记物水平会升高，反映了术后肾脏的损伤情况。这些标记物的变化可能与手术过程中对肾脏的直接操作及感染性结石本身对肾脏的炎症反应和损伤有关。通过监测这些标记物的变化，医生可以评估手术对肾脏功能的影响，并及时采取相应的治疗措施。本研究强调了术后监测肾损伤标记物的重要性，为预防慢性肾病进展提供了依据。Abstract: Objective To investigate the changes in markers of kidney injury in patients with infectious kidney stones after undergoing flexible ureteroscopic lithotripsy, so as to evaluate the early damage of postoperative renal function and provide guidance for clinical treatment. Methods A total of 174 patients with stones admitted to the Department of Urology of Third Medical Center PLA General Hospital from August 2023 to June 2024 were enrolled and divided into control group and infectious stone group according to the results of postoperative stone composition analysis. All patients underwent flexible ureteroscopic lithotripsy. Urine samples were collected at different time points before and after surgery, and enzyme-linked immunosorbent assay (ELISA) was used to detect kidney injury molecule 1 (KIM-1) and neutrophil gelatinase-associated lipocalin (NGAL) in urine. Data analysis was performed using statistical software. Results There was no significant difference in baseline data between the two groups, and the data were comparable. There were no significant differences in surgery-related measures(operation time, length of postoperative hospital stay, complication rate, and stone clearance rate) between the two groups. The levels of urine leukocytes and urea nitrogen in the preoperative infectious stone group were significantly higher than those in the control group, and the level of urea nitrogen in the postoperative infectious stone group was still higher than that in the control group. The detection of renal injury markers showed that the levels of KIM-1 and NGAL in the urine 3 hours after surgery in the infectious stone group were higher than those in the preoperative level and control groups, and the difference was statistically significant(P < 0.05). The markers of urine kidney injury in the control group and the infectious stone group reached the highest value about 3 hours after surgery, and showed a downward trend thereafter. Conclusion After flexible ureteroscopic lithotripsy, the level of urine kidney injury markers in patients with infectious kidney stones will increase, reflecting the postoperative kidney injury. Changes in these markers may be related to the direct manipulation of the kidneys during surgery and the inflammatory response and damage to the kidneys by the infectious stones themselves. By monitoring changes in these markers, doctors can assess the impact of surgery on kidney function and take appropriate treatment measures in a timely manner. This study highlights the importance of postoperative monitoring of markers of kidney injury and provides a basis for preventing the progression of chronic kidney disease.
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表 1 2组患者基线资料比较
X±S，例(%) 项目 对照组(138例) 感染性结石组(36例) t/χ2 P值 年龄/岁 54.33±12.52 52.19±14.02 -0.682 0.497 男性/例(%) 84(60.9) 19(52.8) 0.510 0.475 BMI/(kg/m2) 25.06±2.95 26.38±3.77 1.648 0.104 左侧结石/例(%) 71(51.4) 20(55.6) 0.056 0.813 结石直径/cm 1.67±0.51 1.66±0.37 -0.084 0.933 结石密度/HU 739.08±316.08 868.23±271.02 1.861 0.067 
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表 2 2组患者手术相关指标比较
X±S，例(%) 指标 对照组(138例) 感染性结石组(36例) t/χ2 P值 手术时间/min 74.44±23.47 75.88±40.97 0.184 0.855 术后住院天数/d 1.61±0.76 1.66±0.89 0.283 0.778 并发症 12(8.7) 6(16.7) 1.143 0.285 结石清除 129(93.5) 33(91.7) 1.059 0.303
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表 3 2组患者手术前后临床检验指标比较
X±S 指标 术前 术后 对照组 感染性结石组 t/χ2 P值 对照组 感染性结石组 t/χ2 P值 尿白细胞/(个/μL) 17.31±20.09 424.17±693.78 3.517 0.001 118.36±125.21 210.43±338.52 1.531 0.133 尿红细胞/(个/μL) 1 782.43±3 881.14 4 961.73±11 633.36 1.555 0.127 3 495.08±6 969.12 6 673.06±11 478.86 1.799 0.078 SCr/(μmol/L) 86.77±22.75 89.82±25.21 0.573 0.569 85.88±23.43 82.85±16.97 -0.627 0.533 BUN/(mmol/L) 4.89±1.34 6.01±1.62 3.177 0.002 4.76±1.32 5.81±1.65 2.958 0.004 血红蛋白/(g/L) 140.41±14.46 136.11±14.93 -1.243 0.218 136.08±13.15 133.66±14.21 -0.749 0.457
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表 4 2组患者肾损伤尿液标记物比较
X±S 时间 KIM-1/(pg/mL) NGAL/(ng/mL) 对照组 感染性结石组 t/χ2 P值 对照组 感染性结石组 t/χ2 P值 术前 356.99±72.42 395.50±82.79 2.100 0.039 4.19±0.27 4.24±0.44 0.563 0.576 术后3 h 642.93±212.031) 890.72±74.381) 6.616 ＜0.001 5.33±0.651) 6.36±1.011) 5.145 ＜0.001 术后6 h 447.97±112.691) 483.34±107.811) 1.360 0.178 4.31±0.52 4.33±0.37 0.166 0.868 术后12 h 399.89±117.94 436.00±77.931) 1.533 0.130 4.19±0.44 4.11±0.36 -1.885 0.442 术后24 h 344.51±93.22 364.38±83.03 0.955 0.343 4.02±0.42 4.17±0.31 -1.766 0.082 与同组内术前比较，1)P＜0.05。
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