Molekulyarnaya Meditsina (Molecular medicine)Molekulyarnaya Meditsina (Molecular medicine)Молекулярная медицина1728-29182499-9490Russkiy Vrach Publishing House11358210.29296/24999490-2022-02-07ArticlesСтатьиResearch ArticleРurinergic regulation of stones elimination from the upper part of the ureter during lithokinetic therapyПуринергическая регуляция элиминации конкрементов из верхнего отдела мочеточника при литокинетической терапииBarinovEdward FedorovichБариновЭдуард Федорович

Head of the department the Histology, Cytology and Embryology State educational organization of higher professional education

заведующий кафедрой гистологии, цитологии и эмбриологии

barinov.ef@gmail.comMalininYury YuryevichМалининЮрий Юрьевич

Head at the Department of Urology State educational organization of higher professional education; Candidate of Medical Sciences

заведующий кафедрой урологии; Кандидат медицинских наук.

jora2@list.ruGrigoryanKhachen VladimirovichГригорянХачен Владимирович

assistant at the Department of Urology State educational organization of higher professional education; Candidate of Medical Sciences.

ассистент кафедры урологии; Кандидат медицинских наук

khachengrigoryan@gmail.comState educational organization of higher professional education «M. Gorky Donetsk National Medical University»ГОО ВПО «Донецкий национальный медицинский университет им. М. Горького»15022022202VOL 20, NO2 (2022)ТОМ 20, №2 (2022)465218112022Copyright ©; 2022, Russkiy Vrach Publishing HouseCopyright ©; 2022, ИД "Русский врач"2022Russkiy Vrach Publishing HouseИД "Русский врач"https://journals.eco-vector.com/1728-2918/article/view/113582

The reasons for the low efficiency of the α1A-blockers using in the scheme of lithokinetic therapy (LCT) remain unclear. The aim of the study was to evaluate the activity of the purinergic P2X1 receptor in the blockade of the α1A-adrenergic receptor during LCT in patients with calculi localization in the upper third of the ureter. Material and methods. The study was prospective and included 61 patients with calculi in the upper third of the ureter. For 7 days, patients underwent standard LBT, including an α1A-blocker, non-steroidal anti-inflammatory drugs (NSAIDs), and antibiotics. According to the imaging control of calculus traffic, the cohort of patients was divided into two groups: with effective (group 1) and ineffective (group 2) elimination of calculus. The activity of the P2X1 receptor was studied in vitro on a suspension of platelets. Platelet aggregation was assessed by the turbidimetric method using a ChronoLog analyzer (USA). Results. During hospitalization of patients, the P2X1-receptor hyperreactivity was revealed. When the standard LCT was prescribed after 7 days in the 1st group, the elimination of calculi from the upper third of the ureter was observed; the effect was reproduced in case of P2X1 receptor hyporeactivity. Fast and slow elimination of calculi. was determined by the kinetics of inhibition of ATP-induced intracellular signaling. In group 2, this phenomenon was not reproduced, while the P2X1 receptor hyperreactivity persisted for 7 days. According to the results of modeling the risk of ineffective elimination of calculi 72 h after the onset of LCT, the critical threshold of P2X1 receptor activity (P2X-R crit) was >58%. Conclusion. The effectiveness of LCT, associated, among other things, with the appointment of blockers of α1A-adrenergic receptors, is dependent of the activity P2X1 receptor, which modulates the contraction of the muscular layer of the ureter.

До настоящего времени причины низкой эффективности назначения а1-адреноблокаторов в схеме литокинетической терапии (ЛКТ) остаются невыясненными. Цель исследования - оценить активность пуринергического Р2Х1-рецептора на фоне блокады α1Л-адренорецептора в процессе ЛКТ у пациентов с локализацией конкрементов в верхней трети мочеточника. Материал и методы. Исследование носило проспективный характер и включало 61 пациента с наличием конкрементов в верхней трети мочеточника. В течение 7 сут пациентам проводили стандартную ЛКТ, включающую α1А-адреноблокатор, нестероидные противовоспалительные препараты (НПВП) и антибиотики. По данным визуализационного контроля траффика конкремента когорту больных распределили на 2 группы: эффективной (1-я группа) неэффективной (2-я группа) элиминацией конкремента. In vitro на суспензии тромбоцитов исследовали активность Р2Х1-рецептора. Оценку агрегации тромбоцитов проводили турбидиметрическим методом на анализаторе ChronoLog (США). Результаты. На момент госпитализации у пациентов выявлена гиперреактивность Р2Х1-рецептора. При назначении стандартной ЛКТ через 7 сут у пациентов 1-й группы наблюдалась элиминация конкрементов из верхней трети мочеточника; эффект достигался на фоне гипореактивности Р2Х1-рецептора. Кинетика ингибирования АТФ-индуцированной внутриклеточной сигнализации определяла быструю и медленную элиминацию конкрементов. Во 2-й группе данный феномен не воспроизводился, при этом у пациентов на протяжении 7 сут сохранялась гиперреактивность Р2Х1-рецептора. По результатам моделирования риска неэффективной элиминации конкрементов через 72 ч после начала ЛКТ критический порог активности Р2Х1-рецептора (Р2Х-R crit) составил >58%. Заключение. Эффективность ЛКТ, связанной в том числе с назначением блокаторов α1А-адренорецепторов, зависит от активности Р2Х1-рецептора, который модулирует сокращение мышечной оболочки мочеточника.

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