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目的:探讨体外冲击波碎石术(ESWL)和输尿管镜下气压弹道碎石术(URS-PL)对输尿管下端结石患者T细胞亚群和自然杀伤细胞(NK细胞)的影响及临床意义。方法:收集本院输尿管下段结石61例,行体外冲击波碎石术31例(ESWL组),行输尿管镜下气压弹道碎石术30例(URS-PL组),两组患者分别于术前1天、术毕30 min、术后1天以及术后4天抽取肘静脉血,通过流式细胞仪检测T细胞亚群和NK细胞。统计并比较分析两组患者T细胞亚群、T细胞增殖活性、NK细胞含量以及杀伤活性。结果:ESWL组术后CD_3~+、CD_4~+ T细胞比例、CD_4/CD_8比值、NK细胞比例和杀伤活性无明显变化;URS-PL组术后1天CD_3~+、CD_4~+T细胞比例、CD_4/CD_8比值、NK细胞比例和杀伤活性明显下降(P<0.05),与ESWL组比较差异有统计学意义(P<0.05),术后4天恢复正常。ESWL组与URS-PL组患者围手术期T细胞增殖变化比较差异无统计学意义(P>0.05)。结论:治疗输尿管下段结石,体外冲击波碎石术相对输尿管镜下气压弹道碎石术对T细胞亚群和NK细胞的抑制更细微。免疫应答反应作为监测机体创伤程度这一因素将对选择ESWL和URS-PL治疗输尿管下段结石具有临床指导价值。
Objective: To investigate the effect and clinical significance of extracorporeal shock wave lithotripsy (ESWL) and ureteroscopic pneumatic lithotripsy (URS-PL) on T cell subsets and natural killer cells (NK cells) in patients with lower ureteral calculi. Methods: Sixty-one patients underwent ureteroscopic pneumatic lithotripsy (URS-PL group) were enrolled in this study. Sixty-one patients underwent ureteral endoscopic lithotripsy (ESWL) and 61 patients underwent ureteral lithotripsy Day, 30 min after operation, 1 day after operation and 4 days after operation. T lymphocyte subsets and NK cells were detected by flow cytometry. Statistics and comparative analysis of two groups of patients T cell subsets, T cell proliferation activity, NK cell content and killing activity. Results: There was no significant difference in the proportion of CD_3 ~ +, CD_4 ~ + T cells, CD_4 / CD_8 ratio, NK cell ratio and cytotoxicity in ESWL group. The proportion of CD_3 ~ + and CD_4 ~ + T cells , The ratio of CD 4 / CD 8, the ratio of NK cells and the cytotoxicity of NK cells were significantly decreased (P <0.05). The difference was statistically significant compared with ESWL group (P <0.05). There was no significant difference in perioperative T cell proliferation between ESWL group and URS-PL group (P> 0.05). Conclusion: The treatment of lower ureteral stones, extracorporeal shock wave lithotripsy ureteroscopic pneumatic lithotripsy on T cell subsets and NK cells inhibition more subtle. The immune response as a measure of the extent of traumatic injury in the body will be of clinical guidance for the selection of ESWL and URS-PL for the treatment of lower ureteral calculi.