ABSTRACT
Objective:To investigate the activation level of neutrophil extracellular trap (NET) in the bile of patients with choledocholithiasis and its clinical significance.Methods:From May 2021 to October 2022, 130 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) at the Department of Gastroenterology, the First Affiliated Hospital of Anhui Medical University were enrolled. The patients were divided into choledocholithiasis group (90 cases) and non-choledocholithiasis group (40 cases), and the choledocholithiasis group was further divided into large stone group (maximum diameter >1 cm, 36 cases) and small stone group (maximum diameter≤1 cm, 54 cases). The bile samples were collected from 130 patients during operation and 16 choledocholithiasis patients with nasobiliary drainage at 24 h after operation.The levels of myeloperoxidase(MPO), neutrophilelastase(NE), and citrullinated histone H3(CitH3) in bile were detected by enzyme-linked immunosorbent assay.The levels of MPO, NE, and CitH3 were compared between choledocholithiasis group and non-choledocholithiasis group, between large stone group and small stone group, as well as between choledocholithiasis patients before ERCP and after ERCP. Mann-Whitney U test and Wilcoxon signed rank test were used for statistical analysis. Results:The levels of MPO, NE and CitH3 in the bile of choledocholithiasis group were 32.6 U/L(28.5 U/L), 30.6 ng/L(35.2 ng/L) and 0.37 μg/L(0.73 μg/L), respectively, which were all higher than those of non-choledocholithiasis group (19.9 U/L(36.4 U/L), 18.2 ng/L(27.4 ng/L), and 0.10 μg/L(0.25 μg/L)), and the differences were statistically significant ( Z=2.91, 3.20 and 3.34; P=0.004, 0.001 and 0.001). The levels of MPO, NE and CitH3 of large stone group were 47.0 U/L(49.4 U/L), 48.4 ng/L(39.5 ng/L) and 0.83 μg/L(1.08 μg/L), respectively, which were all higher than those of small stone group (29.3 U/L(17.5 U/L), 24.0 ng/L(25.8 ng/L), and 0.27 μg/L(0.45 μg/L)), and the differences were statistically significant ( Z=2.01, 3.58 and 3.63; P=0.044, <0.001 and <0.001). The levels of MPO, NE and CitH3 in the bile of choledocholithiasis patients after ERCP significantly decreased compare with those before ERCP (19.4 U/L(19.8 U/L) vs. 33.6 U/L(36.7 U/L), 12.7 ng/L(15.1 ng/L) vs. 22.7 ng/L(25.9 ng/L), 0.05 μg/L(0.12 μg/L) vs. 0.14 μg/L(0.27 μg/L)), and the differences were statistically significant ( Z=3.52, 3.30 and 3.18; all P<0.001). Conclusion:The activation level of NET in the bile of patients with choledocholithiasis increase, while the activation level of NET decrease after ERCP, which indicate that NET may be involved in the formation of choledocholithiasis.
ABSTRACT
BACKGROUND:Percutaneous vertebroplasty with bone cement injection has the advantages of minimal invasion, short time, effectively restoring vertebral body height, preventing further colapse of the vertebral body and obvious analgesic effect, which has became an effective method for the treatment of elderly osteoporotic compression fractures. OBJECTIVE:To observe the therapeutic effect of percutaneous vertebroplasty with bone cement injection on elderly osteoporotic compression fractures. METHODS:Sixty-two patients with osteoporotic thoracolumbar vertebral compression fracture, including 22 males and 40 females, aged 55-92 years, involving 86 vertebrae, were included and subjected to percutaneous vertebroplasty with polymethyl methacrylate bone cement injection under C-arm X-ray fluoroscopy. During the postoperative folow-up of 12 to 36 months, visual analogue scale scores, Cobb angle and Oswestry disability index scores were compared before and after the treatment. RESULTS AND CONCLUSION: At 12 to 36 months after treatment, there were 11 cases of complications, including 7 cases of bone cement leakage, 2 cases of adjacent vertebral fractures, 1 cases of bone cement tailing and 1 case of unsatisfactory pain relief. In the final folow-up, Cobb angle, visual analogue scale scores, Oswestry disability index scores were significantly improved compared with those before treatment (P < 0.05).These results demonstrate that percutaneous vertebroplasty with polymethyl methacrylate bone cement injection in the treatment of elderly osteoporotic compression fractures can not only restore vertebral shape, reduce kyphosis, reconstruct spinal stability, but also significantly reduce the pain caused by fractures and improve the life quality of patients. The curative effects in short and medium term are positive.