The Study Of Kidney Stones And Kidney Stone Row Mixture Prevention In Clinical And Experimental

ObjectiveThrough animal experiments and clinical observation of the impact of reinforcing kidney lithagogue mixture on kidney stones, then analyzes the lithagogue and litholysis effect of this mixture on kidney stones, and explores its mechanism for preventing and curing kidney stones, which provides a theoretical basis for clinical treatment of kidney stones.Methods1. The clinical observation of treatment of reinforcing kidney lithagogue mixture to residual kidney stones after PCNL operation.After PCNL operation, randomly divides 49 collected residual kidney stones patients who met the inclusion criteria into treatment group and control group. After being discharged, gives reinforcing kidney lithagogue mixture (50ml, oral,2 times/day) and Tamsulosin Hydrochloride Sustained Release Capsules (0.2mg, after meals,1 time/day) to treatment group patients. After being discharged, gives Tamsulosin Hydrochloride Sustained Release Capsules (0.2mg, after meals,1 time/day) to control group patients. Taken 1 month as a treatment course, urges to drink more water. Two groups patients constantly take medication for a month,1 to 2 months later and back to hospital, removes ureteral stent and reviews KUB, as well as observes the difference of residual stones from that after operation 3 days.2. The mechanism research of reinforcing kidney lithagogue mixture for prevention and treatment of renal calcium oxalate stones(1) Animal experiment grouping and medicine methodThe 40 SPF class male SD rats were randomly divided into five groups, each group’s amount is eight. General feeding is taken in blank Group(14 days). In model group,1% ethylene glycol free drinking water and 2% ammonium chloride are orally taken(2ml/a rat/day) and 10% calcium gluconate intraperitoneal injection 1.5ml/a rat/day (14 days). In resolving-stone group,1% ethylene glycol free drinking water and the reinforcing kidney lithagogue mixture are take in the forenoon(4ml/a rat/day) and 2% ammonium chloride is taken orally (2ml/a rat/day) in the afternoon and intraperitoneal injection of 10% gluconate calcium (1.5ml/a rat/day) (14 days). In litholysis group,1% ethylene glycol free drinking water and 2% ammonium chloride are taken orally (2ml/a rat/day) and intraperitoneal injection of 10% calcium gluconate (1.5ml/a rat/day) (14 days), on 15th day, swift to normal free water and reinforcing kidney lithagogue mixture (4ml/a rat/day) (14 days); In litholysis control group,1% free water glycol and 2% ammonium chloride are orally taken (2ml/a rat/day) and intraperitoneal injection of 10% calcium gluconate (1.5ml/a rat/day) (14 days), on 15th day swift to conventional feeding (14 days).(2) Experimental animals material and observed indicatorsAfter anesthesia, extracts rat aortic blood 4ml and measures serum creatinine degree on 14th and 28th day, respectively. And conducts a complete cut of the right kidney, using 10% formaldehyde solution to maintain, and makes them into HE staining sections, puts under 40 times,100 times and 400 times optical microscope respectively to observe kidney pathological change and sediment condition of calcium oxalate crystals, then left kidney was cut completely, as is weighed, and was made into 10% of kidney tissue homogenate, separately tests protein concentration, malondialdehyde (MDA) content and the vitality of total superoxide dismutase (T-SOD).(3)Statistical analysisAll data were analyzed by SPSS19.0 software for processing and analysis, count data adopt chi-square test, and ranked data adopt rank sum test, measurement data adopt t test. The prompt has no significant difference when P> 0.05, and when P≤0.05, the differences examined is considered to be statistical significance.Results1. The change result derived from the treatment of reinforcing kidney lithagogue mixture to residual stones after PCNL operation, before treatment, compared with the gender and age differences in the two groups of patients, adopts the chi-square test and the t test respectively, the difference has no statistical significance (P> 0.05). After treatment, reviews KUB to display residual stones change condition (narrow, decrease, shift down, unchanged, increase), there has a significant difference between two groups by rank sum test (P<0.05), the effect of treatment group is better than the control group.2. After 14 and 28 days’feeding respectively, kills the rats and draws material, compared the model group with the blank group, the overall SOD activity, MDA concentration, weight and serum creatinine extent of left kidney organization are taken t-test, all the results have a significant difference (P<0.01), the crystal deposition extent of right kidney calcium oxalate is taken a rank sum test, Z=-3.655, P<0.01, which has a significant difference. Compared the resolving-stone group with model group, the left kidney organization is adopted a t test of SOD activity, MDA concentration, weight and serum creatinine, all results have a significant difference (P<0.01), the degree of crystallization deposition of calcium oxalate in right kidney is adopted rank sum test, Z=-2.449, P<0.05, the difference has a statistical significance. Compared litholysis group with litholysis control group, then adopts t test, the MDA content and weight inside the left kidney tissue have a significant difference (P<0.01), and the difference between SOD activity and serum creatinine levels inside the left kidney organization has a statistical significance (P<0.05), the deposition degree of calcium oxalate crystals in left kidney is adopted rank sum test, Z=-2.730, P<0.01, which has a significant difference.3. Visually observed two kidneys, the kidney size in blank group is normal, and the color is red. And the kidney colors of rest four groups of rats show a varying degree of fading or white, the shape has a varying degree of swelling as well, and the difference between the model group and litholysis control group is more obvious. Under an optical microscope, observes the right kidney pathology section, there has no calcium oxalate crystals inside blank group rat kidney, the renal tubules have no significant expansion, the cells of renal cortex and renal medulla are ordered, and have a clear structure and regular glomerular shape. In model group and litholysis control group, in renal medulla and cortex area, calcium oxalate crystals excessively deposit in the renal tubules, and renal cortex is particularly significant, the crystal presents an irregular form that piles like clusters or even gathers into a large sheet, and a large number of inflammatory cells are infiltrated, renal cortex and medulla cells are disorder, renal tubules are significant dilated, glomerular shape is irregular. The resolving-stone group kidney can also be found more crystal deposition, more inflammatory cells are infiltrated, renal cortex and medulla cells are disorder, the irregularity of renal tubular and glomerular dilatation are improved compared with the model group, while the rat kidney of litholysis group has few crystals to be scattered in the various kidney tubules cavity, and renal tubular has a small amount of mild dilation, most renal cortex and medulla cells are ordered regularly, yet has a clear structure, and almost glomerular shape is regular.Conclusion1. The main pathogenesis of kidney stones is not simply a kidney heat, but is mainly deficiency in kidney excess syndrome.2. The reinforcing kidney lithagogue mixture has a certain lithagogue and litholysis role for residual kidney stones after PCNL operation.3. The reinforcing kidney lithagogue mixture can improve renal ischemia and hypoxia state, promote kidney blood circulation, inhibit and improve the renal tubular dilation extent, enhance the ability that renal tissue scavenges oxygen free radicals, and alleviate kidney tissue oxygen assault degree which suffers from free radicals, and inhibit the formation of renal calcium oxalate crystals and reduce the extent of deposition of calcium oxalate crystals in the kidney.4. The mechanism of reinforcing kidney lithagogue mixture for preventing formation of kidney stones may be relate to many factors, for instance, reinforcing kidney lithagogue mixture improve kidney renal ischemia and hypoxia state, the promotion of kidney blood circulation, and enhancement of the ability that renal tissue scavenges oxygen free radicals, and alleviation of kidney tissue oxygen assault degree which suffers from free radicals, and reduction of the kidney inflammation reaction, and renal tubular epithelial cells injury. To protect and repair the damaged renal tubular reduces the adhesion of calcium oxalate crystals so as to prevent kidney stones and achieve a purpose of lithagogue and litholysis.