2型糖尿病大鼠并发心肌病的研究

目的 在大鼠中复制类似人类2型糖尿病模型,观察并发糖尿病性心肌病的情况.方法 取健康雄性SD大鼠120只,体质量180～220 g,按体质量及血糖值分为4组:(1)糖尿病组:40只,高糖高脂饲料喂养,一次性腹腔注射30 mg/kg链脲佐菌素(STZ)溶液;(2)STZ组:30只,普通饲料喂养,一次性腹腔注射30 mg/kg STZ溶液;(3)高糖高脂饲料组:25只,高糖高脂饲料喂养,一次性腹腔注射等容积柠檬酸盐缓冲液溶液;(4)对照组:25只,普通饲料喂养,一次性腹腔注射等容积柠檬酸盐缓冲液溶液.腹腔注射STZ溶液或柠檬酸盐缓冲液溶液后,观察动物饮水、进食及尿量变化.注射后4、8、12、16周,各组分批抽样检查,称取体质量,取血检测空腹血糖、空腹胰岛素、三酰甘油、总胆固醇;处死动物取心脏称质量,取心肌组织行光镜及透射电镜观察.结果 实验饲料喂养1周,各组大鼠体质量、血糖差异无统计学意义(P>0.05);喂养4周,STZ或柠檬酸盐缓冲液注射前,糖尿病组和高糖高脂饲料组大鼠体质量、空腹胰岛素、胰岛素抵抗指数较对照组和STZ组明显升高(P<0.05);糖尿病组与高糖高脂饲料组相比、STZ组和对照组相比差异均无统计学意义(P>0.05).注射后4个时段,糖尿病组和高糖高脂饲料组大鼠血糖、体质量、心脏质量、血三酰甘油、总胆固醇比同时段的对照组和STZ组增高(P<0.05),糖尿病组大鼠的上述指标较高糖高脂饲料组大鼠增加更显著,差异有统计学意义(P<0.05),STZ组和对照组相比差异无统计学意义(P>0.05).心肌光镜和电镜检查结果显示,糖尿病组大鼠心肌细胞肥厚并出现变性、凋亡等显著病变,间质胶原纤维增生;STZ组大鼠心肌无明显病理改变;高糖高脂饲料组大鼠心肌呈现类似糖尿病大鼠病理改变,但与糖尿病组大鼠相比,改变较不明显.结论 2型糖尿病大鼠成模4周后,心脏发生糖尿病性心肌病的病理改变,表现为心肌细胞肥大、变性,间质纤维组织增生,其发生率为100%.     

贞清方对2型糖尿病并发非酒精性脂肪肝大鼠LXRα表达的影响

目的:探讨贞清方对2型糖尿病非酒精性脂肪肝的治疗作用及可能机制.方法:高脂高糖饮食结合小剂量链脲佐菌素(STZ)腹腔注射建立2型糖尿病并发非酒精性脂肪肝大鼠模型.将成模大鼠随机分为模型组、贞清方治疗组和女贞子治疗组( n= 8),并设立正常对照组( n = 10),灌胃治疗8 wk.比较喂养4、8和16 wk时各组大鼠空腹血糖(FBG)、血清甘油三酯(TG)、总胆固醇(TC)、胰岛素(FINs)和胰岛素敏感指数(ISI)的变化.并于喂养16 wk时观察各组大鼠肝脏指数、TG含量和血清丙氨酸转氨酶(ALT)的水平以及病理变化.用PCR法观察大鼠肝X受体(LXRα)及其下游固醇调节元件结合蛋白-1c(SREBP-1c) mRNA的表达,免疫组织化学法观察肝脏LXRα蛋白的表达.结果:灌胃干预8 wk后,与正常组相比,模型组大鼠FBG、血清TG、肝脏指数及肝脏TG含量明显升高(均P<0.01),胰岛素敏感性明显降低( P<0.01),肝脏脂肪变明显加重,肝脏LXRα mRNA、SREBP-1c mRNA和LXRα蛋白的表达明显增多(均P<0.01).与模型组相比,贞清方治疗组大鼠FBG水平、血清TG水平、肝脏指数及肝脏TG含量明显降低(10.94±3.33 mmol/L vs 16.67±4.33 mmol/L; 0.79±0.27 mmol/L vs 1.33±0.33 mmol/L; 5.72±0.81vs 7.61±1.24; 0.041±0.0110 mmol/g vs 0.059±0.0160 mmol/g,均P<0.01),肝脏脂肪变明显改善,肝脏LXRα mRNA、SREBP-1c mRNA和LXRα蛋白的表达明显减少(0.75±0.11 vs1.23±0.17,0.68±0.16 vs 1.07±0.14,0.220±0.071 vs 0.334±0.037,均P<0.01).结论:贞清方对2型糖尿病性非酒精性脂肪肝具有一定的治疗作用,且其治疗作用可能与贞清方能下调非酒精性脂肪肝组织LXRα的表达有关.     

糖尿病大鼠心肌细胞中survivin、p27 mRNA表达及相关蛋白变化的研究

目的 观察糖尿病状态下大鼠心肌细胞中survlvln及p27 mRNA的表达及相关survivin及P27蛋白的变化.方法 35只雄性SD大鼠随机分为对照组(10只)和高脂组(25只).对照组喂养标准饲料,高脂组喂养高脂饲料.喂养8 w后,各组检测空腹血糖、口服糖耐量试验、胰岛素敏感指数(ISI)、血糖钳技术证实高脂组大鼠产生胰岛素抵抗.高脂组随机抽取10只大鼠作为单纯胰岛素抵抗组,其余15只大鼠注射STZ获得糖尿病大鼠模型,空腹血糖>7.8 mmoL/L的大鼠纳入糖尿病组,继续高脂饲料喂养6 w.14 w时各组用RT-PCR方法检测心肌survivin及p27 mRNA变化,采用Western blot方法检测心肌相关survivin及p27蛋白变化.结果 高脂饲料喂养8 W和14 w时,糖尿病组空腹血糖高于对照组和单纯胰岛素抵抗组(P<0.05);糖尿病组ISI与对照组ISI之间有显著性差异(P<0.05);14w时糖尿病组的survivin及p27mRNA表达水平明显低于对照组和胰岛素抵抗组(P<0.05),糖尿病组survivin及p27蛋白表达水平明显低于对照组和胰岛素抵抗组(P<0.05),而对照组和胰岛素抵抗组间无统计学差异.结论 糖尿病状态下survivin及p27mRNA表达水平下调,表明在糖尿病状态下心肌细胞易发生凋亡,进而形成心力衰竭.     

c-myc、c-fos mRNA及相关蛋白在糖尿病大鼠心肌细胞中的表达

目的 观察2型糖尿病状态下大鼠心肌细胞中c-myc、c-fos mRNA及相关蛋白的变化.方法 50只雄性SD大鼠随机分为对照组(15只)和糖尿病组(35只).对照组喂养标准饲料,糖尿病组喂养高脂饲料.喂养8 w后,检测空腹血糖、口服糖耐量试验、胰岛素抵抗指数(IRI)及血糖钳技术,证实糖尿病组大鼠产生了胰岛素抵抗.大鼠腹腔内注射STZ 25 mg/kg,血糖＞7.8 mmol/L为糖尿病大鼠模型,继续用高脂饲料喂养6 w.14 w时,用RT-PCR方法检测两组大鼠心肌c-myc、c-fos mRNA变化,用Western blot方法检测心肌相关c-myc、c-fos蛋白变化.结果 高脂饲料喂养8 w时,糖尿病组空腹血糖高于对照组(P＜0.05);IRI较对照组明显升高(P＜0.05).14 w时,糖尿病组体重和空腹血糖高于对照组(P＜0.05),c-myc mRNA表达水平与对照组比较无显著性差异,c-fos mRNA表达水平较对照组明显降低(P＜0.05),c-myc蛋白表达水平与对照组比较无显著性差异,c-fos蛋白表达水平较对照组明显降低(P＜0.05).结论 c-myc、c-fos mRNA及其蛋白在糖尿病心肌中的表达可能存在时相性,c-fos mRNA及其蛋白在糖尿病心肌病变的分子水平信号通路中异常表达,可能与糖尿病心肌病的发生发展相关.     

藻蓝蛋白对2型糖尿病大鼠血糖的调节作用

目的 研究藻蓝蛋白对糖尿病大鼠胰岛细胞功能的影响及其可能机制.方法 健康雄性Wistar大鼠30只,应用高脂高糖饲料喂养联合小剂量链脲佐菌素(STZ)腹腔注射方法建立2型糖尿病大鼠模型,藻蓝蛋白灌胃治疗,TUNEL法检测胰岛细胞凋亡,免疫组化技术检测胰岛细胞核因子-κB(NF-κB)和NF-κB抑制蛋白(I-κB)的表达.结果 大鼠造模成功后空腹血糖明显升高,经藻蓝蛋白治疗后空腹血糖较模型组显著降低(P＜0.05).糖尿病模型组大鼠胰岛细胞凋亡指数显著升高、NF-κB表达明显增强,I-κB表达明显下降.经藻蓝蛋白治疗后,大鼠胰岛细胞NF-κB表达较模型组明显降低,I-κB表达较显著增强,细胞凋亡指数显著降低(P＜0.05).结论 藻蓝蛋白可抑制2型糖尿病大鼠胰岛细胞中I-κB/NF-κB通路的活性,对胰岛细胞具有一定的保护作用.     

针刺对糖尿病大鼠下丘脑弓状核IRS1/PI3K途径的影响

目的探讨糖尿病大鼠下丘脑弓状核IRS1/PI3K信号通路以及针刺对该通路的影响。方法高脂高糖喂养后腹腔注射链脲佐菌素(STZ)诱发糖尿病大鼠模型,分为针刺组和模型组,干预4 w后,分别用实时荧光定量PCR和Western印迹测定下丘脑弓状核INSR、ISR1、PI3K、GLUT4 mRNA和蛋白表达。结果糖尿病模型大鼠存在高血糖、高胰岛素血症,下丘脑弓状核INSR、ISR1、PI3K、GLUT4 mRNA和蛋白表达均显著降低;针刺组大鼠空腹血糖和血清胰岛素水平比模型组明显下降,下丘脑弓状核INSR、ISR1、PI3K、GLUT4 mRNA和蛋白表达均比模型组明显增加。结论STZ诱导的糖尿病大鼠存在中枢胰岛素抵抗,IRS1/PI3K是其重要的中枢信号通路,针刺对中枢IRS1/PI3K通路有着良性调节作用,从而改善了STZ诱导的糖尿病大鼠的中枢胰岛素抵抗状态。     

类似人类老年糖尿病大鼠模型之形态学变化

目的 采用D-半乳糖加高脂高糖乳剂及链脲佐菌素(STZ)构建类似老年人糖尿病的大鼠动物模型,观察其胰腺形态学变化.方法 选用健康Wistar雌性大鼠,20只灌胃生理盐水为正常对照组;20只采用腹腔注射D-半乳糖40 d为衰老模型组;另25只则采用腹腔注射D-半乳糖40 d并灌胃高脂高糖乳剂30 d后腹腔注射STZ(体重≤200 g按30 mg/kg,体重＞200 g者按体表面积进行计算),制备衰老糖尿病模型大鼠,筛选空腹血糖≥11.1 mmol/L者为成模鼠,上述各组大鼠再继续灌胃生理盐水10 d后,各组随机取10个样本以免疫组化、光镜和电镜分别观察大鼠胰岛诱导型一氧化氮合酶(iNOS)表达、胰腺细胞凋亡、胰岛形态及胰岛细胞和腺泡细胞超微结构变化.结果 衰老模型组大鼠胰岛iNOS表达量和胰腺细胞凋亡数较正常对照组增加,衰老糖尿病模型组胰岛iNOS表达量和胰腺细胞凋亡数剧增达3倍以上.HE染色显示,衰老模型组胰岛数量、面积仅为正常的50%～70%,衰老糖尿病模型组胰岛数量、面积仅为正常的20%～30%,且岛内中心部细胞(β细胞)消失尤为显著.电镜观察显示,衰老糖尿病模型组大鼠胰腺细胞明显脱颗粒,呈现膜性结构皱缩,核染色质固缩、碎裂等细胞凋亡征象.结论 采用腹腔注射D-半乳糖加高脂高糖乳剂及腹腔注射STZ,胰腺形态组织学证实大鼠在衰老模型基础上胰岛β、D细胞数量进一步下降可引发糖尿病.     

类似人类老年糖尿病大鼠模型胰腺形态学变化

目的采用D-半乳糖加高脂高糖乳剂及链脲佐菌素(STZ)构建类似老年人糖尿病的大鼠动物模型,观察其胰腺形态学变化。方法选用健康Wistar雌性大鼠,20只灌胃生理盐水为正常对照组;20只采用腹腔注射D-半乳糖40d为衰老模型组;另25只则采用腹腔注射D-半乳糖40d并灌胃高脂高糖乳剂30d后腹腔注射STZ(体重≤200g按30mg/kg,体重200g者按体表面积进行计算),制备衰老糖尿病模型大鼠,筛选空腹血糖≥11.1mmol/L者为成模鼠,上述各组大鼠再继续灌胃生理盐水10d后,各组随机取10个样本以免疫组化、光镜和电镜分别观察大鼠胰岛诱导型一氧化氮合酶(iNOS)表达、胰腺细胞凋亡、胰岛形态及胰岛细胞和腺泡细胞超微结构变化。结果衰老模型组大鼠胰岛iNOS表达量和胰腺细胞凋亡数较正常对照组增加,衰老糖尿病模型组胰岛iNOS表达量和胰腺细胞凋亡数剧增达3倍以上。HE染色显示,衰老模型组胰岛数量、面积仅为正常的50%～70%,衰老糖尿病模型组胰岛数量、面积仅为正常的20%～30%,且岛内中心部细胞(β细胞)消失尤为显著。电镜观察显示,衰老糖尿病模型组大鼠胰腺细胞明显脱颗粒,呈现膜性结构皱缩,核染色质固缩、碎裂等细胞凋亡征象。结论采用腹腔注射D-半乳糖加高脂高糖乳剂及腹腔注射STZ,胰腺形态组织学证实大鼠在衰老模型基础上胰岛β、D细胞数量进一步下降可引发糖尿病。     

糖尿病大鼠心肌细胞凋亡与Caspase-8及蛋白激酶C-β表达的相关性研究

目的 通过研究糖尿病大鼠心脏中的细胞凋亡,Caspase-8及蛋白激酶C(PKC)-β的表达来探讨糖尿病心肌病(DCM)的组织学改变与细胞分子水平改变的相互关系.方法 实验大鼠分为4组:(1)糖尿病组,64只,用高糖高脂饲料喂养,予链脲佐菌素(STZ)30 mg/L一次性腹腔注射复制糖尿病模型.(2)正常对照组,37只,饲以普通饲料,腹腔注射柠檬酸盐缓冲液代替STZ.(3)STZ组,42只,饲以普通饲料,腹腔注射STZ.(4)高糖高脂组,37只,饲以高糖高脂饲料,腹腔注射柠檬酸盐缓冲液.在不同时段,抽样检查动物:观察心脏病理组织学变化;用实时荧光定量(PCR)等技术检测心肌Caspase-8及PKC-β的表达;用流式细胞术检测心肌的凋亡.比较不同组间的差异.结果 (1)造模型成功后,糖尿病组大鼠体质量较对照组明显下降(P＜0.05),且随着病程的进展呈下降趋势.高糖高脂组体质量一直较高,各时间段无明显改变.糖尿病组的血糖一直都高于对照组、STZ组及高糖高脂组(P＜0.05);高糖高脂组和对照组血糖差异无统计学意义.(2)糖尿病组细胞凋亡有随着病程延长而增高的趋势.(3)造模型成功后,Caspase-8、PKC-β的表达,糖尿病组高于对照组,而且有随着病程的延长增加的趋势.(4)糖尿病组发生心肌肥大、纤维化,随着病程的延长,病变有逐渐加重的病理特点.(5)相关分析提示,糖尿病组16周时,血糖和心肌细胞凋亡与Caspase-8、PKC-β的表达呈正相关.结论 Caspase-8表达失衡与DCM的发病有关.PKC-β在DCM中起到了一定的作用.高血糖在DCM的发病中起重要的作用.

Abstract：

Objective To study the roles of abnormal expressions of Caspase-8 and protein kinase C(PKC)-β of cardiomyocytes in the development of the apoptosis of cardiomyocyte in diabetic rat. Methods Rats were divided into 4 groups:(1)normal control (NC, n=37),(2)rats given STZ injection and normal diet(STZ,n= 42), (3) rats fed with high fat and high sngar ( HFS, n= 37), (4)rats given STZ injection and high fat and high sugar diet (type 2 DM, n=64). Plasma glucose, insulin and lipids were detected. At the end of experiment, the animals were sacrificed, and their hearts were examined. Pathological changes were observed and the expressions of Caspase-8, PKC-β mRNA were determined by real time-PCR method; apoptosis was analyzed by flow cytometry. Results (1)The body weight was higher in HFS group than in other three groups, and progressively decreased in type 2 diabetes group. The glucose level was highest in diabetic group, and was similar between groups of HFS and NC. (2)The apoptosis showed tendency to ascend during course of disease in diabetes model group. (3)The expressions of Caspase-8 and PKC-β mRNA were significantly enhanced in diabetes model group than in normal control group, and had a tendency to ascend during the course of disease.(4)The myocardial cells of the diabetic rats were rarified and swelling, fibrosis was observed. (5)At the 16th week, the level of plasma glucose was correlated positively with the expressions of Caspase-8 and PKC-β mRNA. Conclusions The enhancement of expressions of Caspase-8 amd PKC-β may play iportat rols in the pathogenesis of diabetic cardiomyopathy,in which apoptosis of the cardiomyocytes increased.     

二甲双胍对2型糖尿病大鼠胆固醇代谢途径的影响

目的探讨二甲双胍对2型糖尿病大鼠胆固醇代谢相关基因SREBP-2,HMGR,LDLR,CYPA7a1的影响及其作用机制。方法 60只雄性Wistar大鼠随机分为正常对照组(CON),2型糖尿病组(DM),二甲双胍治疗糖尿病组(DM+MET)。CON组给予标准饮食,DM组及DM+MET组高脂饮食8 w给予小剂量STZ腹腔注射,建立2型糖尿病模型。造模成功后,DM+MET组给予二甲双胍灌胃治疗(500 mg·kg-1·d-1)。12 w后检测各组大鼠FPG、FINS、TG、TC、LDL-C、HDL-C、TBA等血清生化学指标。HE染色观察各组大鼠肝脏形态变化。荧光实时定量PCR技术检测各组大鼠肝脏SREBP-2、HMGR、LDLR、CYP7a1 mRNA表达水平。结果 DM组与CON组比较FPG、FINS、TG、TC、LDL-C、TBAs表达升高(均P<0.05)。HE染色肝脏脂质沉积,脂肪空泡明显增多。CYP7a1 mRNA表达升高(P<0.05),SREBP-2、HMGR、LDLR mRNA表达降低(均P<0.05);DM+MET组与DM组比较FPG、FINS、TG、TC、LDL-C、TBAs表达降低(均P<0.05)。HE染色肝脏脂肪空泡明显减少。SREBP-2、HMGR、LDLR、CYP7a1 mRNA表达升高(P<0.001)。结论二甲双胍使糖尿病大鼠肝脏组织SREBP-2 mRNA及下游基因HMGR、LDLR表达上调,促进胆固醇合成和吸收,另一方面,二甲双胍可使CYP7a1 mRNA表达上调,促进胆固醇转变为胆汁酸,加速胆固醇降解,二甲双胍通过协调胆固醇的合成途径和转化途径促进胆固醇代谢,进而降低2型糖尿病大鼠血浆胆固醇水平。     

MNA-SF在老年高血压患者营养评价中的应用研究

目的探讨简易营养评价精法在老年高血压患者中运用的可行性。方法利用MNA-SF量表对老年高血压患者的营养状况做调查。结果 MNA-SF量表结果显示,营养不良者占11%,营养正常者占89%。结论 老年高血压患者仍存在营养不良的现象,应加强护理和健康教育。MNA-SF在老年高血压患者的营养评价中有一定的实用价值。     

Complications associated with the treatment of haemophiliacs with inhibitors

To examine the safety profile of products used to treat inhibitor patients unresponsive to factor VIII, a review of published clinical experience was performed. The products evaluated were activated prothrombin complex concentrates (aPCCs), such as AUTOPLEX® T, porcine factor VIII and recombinant activated factor VII (rVIIa). Safety characteristics included potential for transmission of infectious agents, anamnesis, thrombogenicity, thrombocytopenia and allergic reactions. While viral transmission has been virtually eliminated, the risk is theoretically higher with plasma-derived products such as aPCC and porcine factor VIII than with rVIIa, although contamination of cultured cells is a concern. Anamnesis occurs with aPCCs and porcine factor VIII, and may induce resistance to further therapy with porcine factor VIII. Thrombosis and disseminated intravascular coagulation are very infrequently reported in patients exposed to aPCCs and rVIIa, and never with porcine factor VIII. The latter is occasionally associated with thrombocytopenia, but this uncommonly limits treatment with this agent. Lastly, allergic reactions occur with about equal frequency with all products, but anaphylaxis is mainly a concern after administration of porcine factor VIII. In conclusion, products currently available are reasonably safe. Considerations such as efficacy, availability, ease of administration and cost must also be considered in making treatment choices.     

Complications associated with the treatment of haemophiliacs with inhibitors

To examine the safety profile of products used to treat inhibitor patients unresponsive to factor VIII, a review of published clinical experience was performed. The products evaluated were activated prothrombin complex concentrates (aPCCs), such as AUTOPLEX® T, porcine factor VIII and recombinant activated factor VII (rVIIa). Safety characteristics included potential for transmission of infectious agents, anamnesis, thrombogenicity, thrombocytopenia and allergic reactions. While viral transmission has been virtually eliminated, the risk is theoretically higher with plasma-derived products such as aPCC and porcine factor VIII than with rVIIa, although contamination of cultured cells is a concern. Anamnesis occurs with aPCCs and porcine factor VIII, and may induce resistance to further therapy with porcine factor VIII. Thrombosis and disseminated intravascular coagulation are very infrequently reported in patients exposed to aPCCs and rVIIa, and never with porcine factor VIII. The latter is occasionally associated with thrombocytopenia, but this uncommonly limits treatment with this agent. Lastly, allergic reactions occur with about equal frequency with all products, but anaphylaxis is mainly a concern after administration of porcine factor VIII. In conclusion, products currently available are reasonably safe. Considerations such as efficacy, availability, ease of administration and cost must also be considered in making treatment choices.     

Clinical experience with duodenum-preserving total resection of the head of the pancreas with pancreaticocholedochoduodenostomy

The results of duodenum-preserving total resection of the head of the pancreas (DpTRHP) in 20 patients were compared with the results of pylorus-preserving pancreatico-duodenostomy (PpPD), a procedure in conventional use for the treatment of benign diseases, in 19 patients. The mean operative time for DpTRHP was 4.5±0.9 h, this being not significantly different from that for PpPD, whereas the mean intraoperative blood loss with DpTRHP (825±508ml) was significantly less than that with PpPD (1382±798 ml) (P<0.05). The morbidity and mortality rates of patients treated with DpTRHP were 25% and 0%, respectively, and there were no significant differences between the two surgical treatment groups for these values. The outcome of treatment with DpTRHP was excellent, as was that of PpPD, in terms of the frequency of early gastric stasis, the duration of hospital stay, the patient's capacity for taking food, gaining weight, and working, and the performance status 6 months postoperatively. Thus, DpTRHP, which entails the least extent of resection of the head of the pancreas compared to other currently employed procedures and enables the operator to accomplish reconstruction of the pancreatic and biliary systems without resecting or interrupting the continuity of the digestive tract, was not attended by any serious complications, while, digestive tract function was well preserved, and satisfactory results were produced.     

Experience with the treatment of patients with hypertrophic cardiomyopathy with obsidan and isoptin

Forty-five patients with hypertrophic cardiomyopathy were examined clinically and echocardiographically. The results of their treatment with obsidan and isoptin in relation to various types of central hemodynamic disorders are presented. The data have been obtained making it possible to treat patients differentially with regard to the form of the disease. The treatment of this category of patients requires the echocardiographic monitoring of the parameters of the central hemodynamics and myocardial contractility.