梗阻性黄疸并发肾功能损害的实验研究

目的　研究梗阻性黄疸 (OJ)并发肾功能损害的模式及肠源性内毒素血症在其中的作用。方法　雄性Wistar大鼠 5 0只随机均分为假手术 (SO)、胆总管结扎术后 5d(CBDL5d)、10d(CBDL10d)、15d(CBDL15d)及胃饲脱氧胆酸钠治疗 (CBDL +DC)组 ,监测血浆内毒素 (ETX)水平和肾功能指标对氨基马尿酸清除率 (CPAH)、菊粉清除率 (CIN)及钠排泄分数 (FENa + )的变化。结果　CBDL大鼠血浆ETX水平随时间推移持续性升高 (P <0 0 5或P <0 0 1) ;CBDL5d组FENa + 较SO组显著升高 (P <0 0 1)、而CIN和CPAH无明显改变 ,术后 10d起肾功能指标进行性减低、CBDL15d组FENa + 已较SO组显著降低 (P <0 0 1) ;胃饲DC治疗可明显降低血浆ETX水平、改善肾功能指标 (P <0 0 5或P <0 0 1)。结论　肾小管水钠重吸收功能抑制是OJ并发肾损害的早期表现 ,随OJ时间延长 ,肾血流量和肾小球滤过率显著降低、肾小管水钠重吸收功能由抑制转向激活状态 ;肠源性内毒素血症在OJ并发肾功能损害中有重要作用

Renal dysfunctions in obstructive jaundice rats

Objective To investigate the time related renal functional changes and the role of gut derived endotoximia in obstructive jaundice. Methods A total of 50 male Wistar rats were equally randomized into 5 groups, that is, sham operation group (SO), common bile duct ligation for 5 d group (CBDL5d), CBDL10d group, CBDL15d group, CBDL+ gavage administration of sodium deoxycholate at 40 mg per day group (CBDL+DC). The plasma endotoxin level was detected, and the renal functions were evaluated by using the following indexes, p-aminohippuric acid clearance(CPAH), inulin clearance(CIN) and fractional sodium excretion(FE Na+ ). Results With the extension of obstructive jaundice, the plasma endotoxin level was increased continuously ( P <0.05, 0.01). Though no change of CPAH and CIN was seen, FENa+ was significantly increased in CBDL5d group ( P <0.01 vs SO). In 10 d after CBDL, all the 3 renal functional indices were decreased gradually, with FENa+ already significantly lower in CBDL15d group than that in SO group ( P <0.01). Administration of sodium deoxycholate by gavage obviously decreased the plasma endotoxin level and ameliorated the renal functions in CBDL rats ( P <0.05, 0.01). Conclusion The inhibition of renal tubular sodium and water re absorption function are the early renal abnormalities in obstructive jaundice. With the extension of obstructive jaundice, renal blood flow and glomerular filtration rate decrease gradually, and renal tubular sodium and water reabsorption function convert from suppressed state to abnormally active state. Gut derived endotoximia may play an important role in renal dysfunction in obstructive jaundice.