背景:接受输尿管软镜(FURS)治疗肾结石(肾结石)的患者人数逐年增加,因此,术后并发症的发展,如急性肾损伤(AKI),血尿和感染可能增加。吞噬白细胞是帮助对抗细菌和病毒等异物的白细胞,它们本质上参与了炎症反应。研究FURS后吞噬白细胞的作用尚未得到广泛研究。该研究的主要目的是评估吞噬白细胞(中性粒细胞和单核细胞)功能的作用,在接受FURS治疗肾结石(肾结石)的患者中。
方法:招募了14名年龄在27至70岁之间(中位数为49.5岁)接受FURS治疗肾结石的连续患者(7名男性,七个女性)。在四个时间点从每个患者收集血样:基线(手术前),然后是手术后30、120和240分钟。通过密度梯度离心技术分离单核(MN)和多形核(PMN)白细胞亚群。通过测量CD62L(L-选择素)的细胞表面表达来研究中性粒细胞和单核细胞的功能,CD11b(Mac-1),CD99和细胞内过氧化氢(H2O2)的产生,通过流式细胞术。
结果:在FURS治疗肾结石后,观察到单核细胞CD62L表达显着增加(p≤0.05);而在中性粒细胞CD62L中观察到显着降低。其他激活标志物CD11b的水平,CD99和H2O2分别对应于单核细胞和中性粒细胞CD62L的增加和减少,虽然变化无统计学意义(p>0.05)。这项研究的限制因素是相对较小的样本量,以及对招聘时间点的限制。
结论:这项研究表明,在FURS治疗肾结石之后,单核细胞被迅速激活并产生有效的活性氧中间体。有趣的是,中性粒细胞中的表达模式表明,这些细胞响应于治疗而失活。本研究中评估的白细胞生物标志物可能在监测“正常”术后反应中起作用。因为任何患者均未发生并发症;或可能有助于预测术后可能发生的潜在感染并发症(例如尿脓毒症)。这个数据,然而,将需要在更大的多中心研究中进行验证和复制。
BACKGROUND: The number of patients undergoing flexible ureterenoscopy (FURS) for the treatment of kidney stones (renal calculi) is increasing annually, and as such the development of post-operative complications, such as acute kidney injury (AKI), haematuria and infection is likely to increase. Phagocytic leukocytes are white blood cells that help fight foreign material such as bacteria and viruses, and they are intrinsically involved in the inflammatory reaction. Investigating the role of phagocytic leukocytes following FURS has not been widely researched. The main aim of the
study was to evaluate the role phagocytic leukocytes (neutrophils and monocytes) function, in patients undergoing FURS for the treatment of kidney stones (renal calculi).
METHODS: Fourteen consecutive patients aged between 27 and 70 years (median 49.5 years) undergoing FURS for the treatment of kidney stones were recruited (seven males, seven females). Blood samples were collected from each patient at four time points: baseline (pre-operatively) followed by 30, 120 and 240 min post-operatively. Mononuclear (MN) and polymorphonuclear (PMN) leukocyte sub-populations were isolated by density gradient centrifugation techniques. Neutrophil and monocyte cell function was investigated by measuring the cell surface expression of CD62L (L-selectin), CD11b (Mac-1), CD99 and the intracellular production of hydrogen peroxide (H2O2), via flow cytometry.
RESULTS: Significant increases was observed in monocyte CD62L expression post FURS for the treatment of kidney stones (p ≤ 0.05); while significant decreases were observed in neutrophil CD62L. The levels of the other activation markers CD11b, CD99 and H2O2 corresponded to the increases and decreases seen in CD62L for monocytes and neutrophils respectively, though the changes were not statistically significant (p > 0.05). Limiting factors for this
study were the relatively small sample size, and restriction on the recruitment time points.
CONCLUSIONS: This
study demonstrates that following FURS for the treatment of kidney stones, monocytes are rapidly activated and produce potent reactive oxygen intermediates. Interestingly, the pattern of expression in neutrophils suggests that these cells are deactivated in response to the treatment. The leukocyte biomarkers assessed during this investigation may have a role in monitoring the \'normal\' post-operative response, as no complications occurred in any of the patients; or may help predict potential infectious complications (e.g. urosepsis) that can occur during the post-operative period. This data, however, will need to be validated and reproduced in larger multi-centre studies.