体外冲击波碎石致肾损伤的磁共振成像及生化指标改变及其临床意义

摘要

目的 探讨体外冲击波碎石致肾损伤的磁共振成像(MRI)及生化指标的变化及临床意义.方法 30例行体外冲击波碎石(ESWL)术的肾结石患者,分别于术前及术后24 h、1周、2周分别进行MRI和生化检查,分析ESWL前后肾的MRI表现及生化指标的变化规律.结果 ESWL术后MRI检查均未见肾周及包膜下血肿,而患肾肾实质即刻有斑片状或条索状的异常信号改变.术前靶区的表观扩散系数(ADC,b=800 s/mm2)测定值明显高于术后24 h、1周,具有统计学差异(P＜0.05),但与术后2周比较,差异无统计学意义(P＞0.05);术前尿NGAL测定值明显低于术后24 h、1周,具有统计学意义(P＜0.05),但与术后2周比较,差异无统计学意义(P＞0.05);术前血清Cys C测定值明显低于术后24 h值,具有统计学意义(P＜0.05),但与术后1、2周比较,差异无统计学意义(P＞0.05);术前术后尿β2-MG测定值变化不大,无统计学差异(P＞0.05).结论 MRI、尿NGAL、血清Cys C对评价ESWL致肾损伤具有较高的敏感性,能为临床预防和治疗ESWL致肾损伤提供客观的依据.%Objective To investigate the changes and clinical significarce of MRI and biochemical indicators in renal injury after extracorporeal shock wave lithotripsy (ESWL).Methods MRI and biochemical tests were performed in 30 patients with renal calculi before and 24 h,1 week and 2 weeks after ESWL.The changes of MRI and biochemical indicators were analyzed.Results MRI examination showed no perinephric or subcapsular hematoma and after ESWL,while the renal parenchyma showed abnormal patchy or funiform signals.The preoperative apparent diffusion coefficient (ADC,b=800 s/mm2)value was significantly higher than the postoperative values measured after 24h and 1 week (P＜0.05),but there was no significant difference between the preoperative value and postoperative value measured after 2 weeks (P＞0.05).Preoperative levels of urinary neutral neutrophil gelatinase associated lipocalin (NGAL) and serum cystatin C (Cys C) were significantly lower than the postoperative levels measured after 24h and 1 week (P＜0.05),but there was no significant difference between the preoperative level and postoperative level measured after 2 weeks (P＞0.05).There was no significant change in urinary β2-MG level before and after ESWL (P＞0.05).Conclusion MRI,urine NGAL,and serum Cyscare sensitive to the evaluation of renal injury after ESWL,which can provide objective information for the prevention and treatment of renal injury after ESWL.