Yildirim Dogan, Donmez Turgut, Sunamak Oguzhan, Mirapoglu Semih, Hut Adnan, Erdogan Nilgun Rukiye, Saglam Zumrut Mine Isık, Kilincaslan Huseyin
Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey.
Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey.
Wideochir Inne Tech Maloinwazyjne. 2017 Jun;12(2):125-134. doi: 10.5114/wiitm.2017.67210. Epub 2017 Apr 13.
Pneumoperitoneum (PP) is known to cause ischemia in kidneys and other intra-abdominal organs because of decreased splanchnic blood flow.
We aimed to determine the degree of renal injury that occurs due to a PP and prolonged PP. We measured renal injury biomarkers and made a histopathological evaluation to estimate the degree of injury and assessed the correlation of biomarkers with histopathological findings.
Twenty-one female Sprague Dawley rats were separated randomly into three groups. Group 1 was the control group and was given anesthesia for 3 h. In group 2, a PP was administered under anesthesia for 1 h. A pneumoperitoneum was administered under anesthesia to animals in group 3 for 3 h.
Pathological analysis showed a significant statistical difference between the 3 groups. In particular, neutrophil gelatinase-associated lipocalin (NGAL) and cystatin C (Cys C) levels at the 24 h and preoperative mean urea levels showed a significant difference between the groups. The 24-hour NGAL level in group 3 was significantly higher than that of group 1. The preoperative Cys C level was higher in group 1 than in either group 2 or 3. Cys C was decreased significantly in group 1 and increased significantly in both groups 2 and 3.
The increase in NGAL and Cys C levels directly correlated with the duration of PP and intra-abdominal pressure, and they are therefore good biomarkers in diagnosing acute renal injury in the early phase. Serum creatinine level is not a good biomarker in the early phase of renal injury.
已知气腹（PP）会因内脏血流量减少而导致肾脏和其他腹腔内器官缺血。
我们旨在确定因气腹及延长气腹时间所导致的肾损伤程度。我们测量了肾损伤生物标志物并进行组织病理学评估以估计损伤程度，并评估生物标志物与组织病理学结果的相关性。
将21只雌性斯普拉格-道利大鼠随机分为三组。第1组为对照组，给予3小时麻醉。第2组在麻醉下进行1小时气腹。第3组动物在麻醉下进行3小时气腹。
病理分析显示三组之间存在显著统计学差异。特别是，24小时时中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和胱抑素C（Cys C）水平以及术前平均尿素水平在各组之间存在显著差异。第3组24小时NGAL水平显著高于第1组。第1组术前Cys C水平高于第2组和第3组。第1组Cys C显著降低，第2组和第3组均显著升高。
NGAL和Cys C水平的升高与气腹持续时间和腹腔内压力直接相关，因此它们是早期诊断急性肾损伤的良好生物标志物。血清肌酐水平在肾损伤早期不是一个良好的生物标志物。
