Park Jong Kwan, Cui Yong, Kim Myung Ki, Kim Young Gon, Kim Suhn Hee, Kim Sung Zoo, Cho Kyung Woo
Department of Urology, Chonbuk National University Medical School, Research Institute of Clinical Medicine of Chonbuk National University Hospital, Chonju, South Korea.
J Urol. 2002 Jul;168(1):38-42.
The role of extracorporeal shock wave lithotripsy (ESWL, Dornier Medizintechnik GmbH, Wessling Munchen, Germany) on plasma nitric oxide (NO) and cyclic nucleotides was investigated. It is known that ESWL increased plasma levels of vasoactive substances.
A total of 28 patients undergoing ESWL for renal (14) and lower ureteral (14) stones participated in a prospective study. Peripheral blood samples were analyzed for plasma nitrite, NO metabolite, cyclic 3', 5'-guanosine monophosphate (cGMP), cyclic 3',5'-adenosine monophosphate and plasma renin activity before, immediately after, 30 and 60 minutes after ESWL. Urine samples were also analyzed for nitrite before, immediately after, 30 and 60 minutes after ESWL. Blood pressure and pulse rate were measured before and after ESWL.
ESWL increased mean plasma nitrite levels. Before, immediately after, 30 and 60 minutes after ESWL mean plasma nitrate plus or minus standard error in patients with renal versus lower ureteral stones was 43.6 +/- 8.5, 52.8 +/- 7.4, 54.0 +/- 8.0 and 52.2 +/- 9.1 versus 27 +/- 5.8, 24.6 +/- 4.7, 23.6 +/- 4.8 and 28.0 +/- 7.1 nM., respectively. Before, immediately after, 30 and 60 minutes after ESWL mean plasma cGMP in patients with renal versus lower ureteral stones was 1.21 +/- 0.1, 1.64 +/- 0.16, 1.52 +/- 0.12 and 1.58 +/- 0.14 versus 1.45 +/- 0.18, 1.52 +/- 0.13, 1.52 +/- 0.15 and 1.51 +/- 0.11 fmol., respectively. Cyclic 3',5'-adenosine monophosphate was not increased by ESWL in patients with renal stones. Urine nitrite increased slightly but not significantly after ESWL. Plasma cyclic nucleotides and nitrite, and urine nitrite were not changed by ESWL in patients with lower ureteral stones. Plasma renin activity decreased significantly in patients with renal stones 60 minutes after ESWL. Blood pressure and pulse rates increased mildly without statistical significance after ESWL for renal stones.
ESWL increases plasma nitrite and cGMP in patients with renal stones, suggesting that shock waves stimulate the NO-cGMP signaling pathway.
研究体外冲击波碎石术（ESWL，德国慕尼黑韦斯林多尼尔医疗技术有限公司）对血浆一氧化氮（NO）和环核苷酸的作用。已知ESWL会增加血管活性物质的血浆水平。
共有28例因肾结石（14例）和输尿管下段结石（14例）接受ESWL治疗的患者参与了一项前瞻性研究。在ESWL治疗前、治疗后即刻、治疗后30分钟和60分钟采集外周血样本，分析血浆亚硝酸盐、NO代谢产物、环3',5'-鸟苷单磷酸（cGMP）、环3',5'-腺苷单磷酸和血浆肾素活性。在ESWL治疗前、治疗后即刻、治疗后30分钟和60分钟也对尿液样本进行亚硝酸盐分析。测量ESWL治疗前后的血压和脉搏率。
ESWL增加了平均血浆亚硝酸盐水平。对于肾结石患者，ESWL治疗前、治疗后即刻、治疗后30分钟和60分钟时，血浆硝酸盐加或减标准误分别为43.6±8.5、52.8±7.4、54.0±8.0和52.2±9.1 nM，而输尿管下段结石患者分别为27±5.8、24.6±4.7、23.6±4.8和28.0±7.1 nM。对于肾结石患者，ESWL治疗前、治疗后即刻、治疗后30分钟和60分钟时，血浆cGMP分别为1.21±0.1、1.64±0.16、1.52±0.12和1.58±0.14 fmol，而输尿管下段结石患者分别为1.45±0.18、1.52±0.13、1.52±0.15和1.51±0.11 fmol。ESWL未使肾结石患者的环3',5'-腺苷单磷酸增加。ESWL治疗后尿液亚硝酸盐略有增加但无显著变化。ESWL未使输尿管下段结石患者的血浆环核苷酸和亚硝酸盐以及尿液亚硝酸盐发生改变。ESWL治疗后60分钟，肾结石患者的血浆肾素活性显著降低。肾结石患者ESWL治疗后血压和脉搏率轻度升高，但无统计学意义。
ESWL增加了肾结石患者的血浆亚硝酸盐和cGMP，提示冲击波刺激了NO-cGMP信号通路。
