腎結石病人經體外震波後尿液蛋白質的變化

黃鶴翔¹、鄭嘉緯²、馬明傑³

^1,2國立成功大學附設醫院泌尿部，³輔仁大學醫學院

The alteration of urinary protein after SWL in the patients with nephrolithiasis

Huang Ho-Shiang¹、Cheng Chia-Wei²、Ma Ming-Chieh³

^1,2Department of Urology, National Cheng Kung University Hospital, Tainan, Taiwan

³ School of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan

Purpose:

We intend to evaluate changes in urinary expression of calcium oxalate (CaOx) binding proteins, comparing with the changes in urinary supersaturation, in the patients with CaOx stone before and after surgical intervention, respectively.

Materials and Methods:

Fifty-four patients with CaOx stone and 30 controls were enrolled in this study. The CaOx binding proteins including nucleolin-related protein (NRP), CXC chemokine receptor 4 (CXCR4), and nuclear pore complex (NPC) p62 were examined semi-quantitatively in 24-h collection of urine samples before and after extracorporeal shock wave lithotripsy (SWL). The degree of urinary supersaturation was estimated by ion-activity product of CaOx [AP(CaOx)index].

Results:

Stone patients showed hyperoxaluria and a higher AP(CaOx)index than normal controls significantly. High AP(CaOx)index seen in stone patients was not affected by intervention of SWL. Stone patients had higher levels of α-glutathione S-transferase (αGST) and πGST and lipid peroxidation than those of the controls. Lipid peroxidation elevation was persisted 2 weeks and 4 weeks after SWL. Before SWL, urinary expressions of CXCR4 and NPC p62 were higher in stone patients as compared to controls. Increases in urinary CXCR4 and NRP were seen in stone patients after 2-week SWL when compared to the levels before SWL, but the expressions of CXCR4, NRP, and NPC p62 decreased significantly in stone patients 4 weeks after SWL when compared to the levels before SWL and after 2 weeks of SWL.

Conclusion:

Stone patients still had hyperoxaluria and hypocitratria after stone removal and both possibly contribute to high urinary CaOx supersaturation and lead to CaOx crystal formation. Therefore, tubular damage and lipid peroxidation still persisted in stone patients though the clinical visible urinary stone was crushed already by SWL.