Evaluation of hemostasis parameters and the role of the oxidative damage to plasma proteins in the modulation of hemostasis in patients with nephrolithiasis before and after extracorporeal shock wave lithotripsy

PurposeExtracorporeal shock wave lithotripsy (ESWL) is a commonly-used method in urology, which may modulate hemostasis and may induce lipid peroxidation in patients with nephrolithiasis. However, previous studies only examine changes occurring in patients 30–240 min after ESWL. The main aim of the present study was to determine whether oxidative stress may modulate the hemostatic activity of plasma in patients with nephrolithiasis before ESWL and the day after treatment ESWL. This will be performed by measuring selected parameters of hemostasis in these patients, both before ESWL and the following day, and assessing the level of oxidative damage to plasma proteins in these patients by measuring two biomarkers.MethodsTwelve patients with nephrolithiasis and 10 healthy participants were included. The following parameters of hemostasis were measured: the activated partial thromboplastin time (APTT), prothrombin time (PT), and thrombin time (TT) of plasma, the level of fibrinogen, the level of D-dimer and blood platelet count. In addition, two selected biomarkers of oxidative stress were measured: protein carbonylation level and the number of protein thiol groups.ResultsNo difference was observed between patients with nephrolithiasis before and after ESWL and healthy controls with regard to PT, TT or APTT. Fibrinogen concentration and blood platelet count were lower in the nephrolithiasis patients in the period after ESWL than before ESWL. The nephrolithiasis patients demonstrated elevated D-dimer concentration after ESWL. However, although oxidative damage was observed in the plasma proteins in the nephrolithiasis patients, this was not influenced by ESWL.ConclusionOxidative stress may induce changes of hemostasis in patients with nephrolithiasis, both before and after ESWL. In addition, changes of hemostasis parameters such as fibrinogen, blood platelet count and D-dimer level can be observed in these patients, especially after ESWL, and this may suggest that ESWL modulates hemostasis. By having a better understanding of the influence of ESWL on hemostasis, this could lead to modifying patient care for those patients at increased risk of bleeding.

目的 体外冲击波碎石术（Extracorporeal shock wave lithotripsy, ESWL）是泌尿外科常用术式，可调节肾结石患者的止血功能，并可能诱导脂质过氧化。然而既往研究仅关注了体外冲击波碎石术后30~240分钟内患者体内的变化。本研究的主要目的是明确体外冲击波碎石术前及术后次日，氧化应激是否可调节肾结石患者血浆的止血活性。本研究将通过检测上述患者体外冲击波碎石术前及术后次日的多项止血相关参数，并通过两种生物标志物测定血浆蛋白的氧化损伤水平，以达成上述研究目标。
方法 本研究纳入12名肾结石患者与10名健康受试者。检测的止血相关参数包括：血浆活化部分凝血活酶时间（activated partial thromboplastin time, APTT）、凝血酶原时间（prothrombin time, PT）、凝血酶时间（thrombin time, TT）、纤维蛋白原水平、D-二聚体水平以及血小板计数。此外，本研究还检测了两种氧化应激相关生物标志物：蛋白羰基化水平与蛋白巯基基团数量。
结果 肾结石患者在体外冲击波碎石术前后与健康对照组相比，PT、TT及APTT均无显著差异。肾结石患者术后的纤维蛋白原浓度与血小板计数较术前降低。术后肾结石患者的D-二聚体浓度升高。尽管在肾结石患者的血浆蛋白中观察到了氧化损伤，但该损伤并未受体外冲击波碎石术的影响。
结论 氧化应激可在体外冲击波碎石术前后影响肾结石患者的止血功能。此外，可在上述患者体内观察到包括纤维蛋白原、血小板计数与D-二聚体水平在内的止血参数变化，尤其在体外冲击波碎石术后，这提示体外冲击波碎石术可调节止血功能。通过深入了解体外冲击波碎石术对止血功能的影响，可为出血风险升高的患者优化诊疗方案提供依据。