肝细胞生长因子与糖尿病肾病

随着人们生活水平的提高及人口老龄化,糖尿病的发病率在全球范围内逐年增多,据统计全球约有1.2亿糖尿病患者,我国约有2 000万糖尿病患者,而糖尿病肾病(dia-betic nephropathies,DN)也在不断增加,DN是糖尿病的严重并发症,其病理变化呈慢性进行性进展,最终导致终末期肾衰竭,是糖尿病死亡的重要原因.     

氯沙坦对糖尿病肾病大鼠炎性反应的抑制作用

糖尿病肾病（DN）是糖尿病（DM）全身微血管病变的表现之一，其发生机制十分复杂。近年来炎性反应学说备受关注，且随着对血管紧张素受体拈抗剂（ARB）类药物研究的日益增多，发现其尚可通过抑制慢性亚临床炎性反应而发挥肾脏保护作用，但机制尚未完全明了。奉研究观察氯沙坦对DM大鼠血CRP、TNF—α水平以及Toll样受体4（TLR4）、NF—κB在肾组织中表达的影响，对其抑制炎性反应的作用机制进行初步的探讨。     

糖尿病大鼠颈动脉窦隔离灌注异丙酚对血浆内皮素及一氧化氮水平的影响

目的 探讨糖尿病大鼠颈动脉窦隔离灌注异丙酚对血浆内皮素(ET)及一氧化氮(NO)水平的影响.方法 健康清洁级成年雄性Wistar大鼠,体重180 ～ 220 g,采用腹腔注射链脲佐菌素30mg/kg的方法制备糖尿病模型.取糖尿病模型制备成功的大鼠36只,采用随机数字表法,将其随机分为3组(n=12):对照组(DC组)、低浓度异丙酚组(DP1组)和高浓度异丙酚组(DP2组).另取非糖尿病大鼠36只,采用随机数字表法,将其随机分为3组(n=12):对照组(NC组)、低浓度异丙酚组(NP组)和高浓度异丙酚组(NP2组).颈动脉窦隔离灌流K-H液(对照组)、含50 μmol/L异丙酚的K-H液(低浓度异丙酚组)和含100 μmol/L异丙酚的K-H液(高浓度异丙酚组),30 min后取股动脉血样,测定血浆ET和NO浓度.结果 与DC组比较,DP1组和DP2组血浆ET浓度降低,NO浓度升高(P＜0.05);与DP1组比较,DP2组血浆ET浓度降低,NO浓度升高,NP1组血浆ET浓度升高,NO浓度降低(P＜0.05);与DP2组比较,NP2组血浆ET浓度升高,NO浓度降低(P＜0.05).结论 异丙酚可通过对颈动脉窦压力感受器的局部作用降低糖尿病和非糖尿病大鼠血浆ET水平,升高NO水平,且对糖尿病大鼠的效应更强.     

氯沙坦钾对糖尿病肾病大鼠肾组织p-JAK2、p-STAT3及VEGF表达的影响

目的：探讨氯沙坦钾对糖尿病肾病（diabetic nephropathy,DN）大鼠肾组织 p - JAK2、p - STAT3及 VEGF 表达的影响。方法：健康雄性 SD 大鼠30只随机分为正常对照组（C 组）、DN 模型组（DN 组）、氯沙坦钾组（L 组）。采用单次腹腔内注射链脲佐菌素（streptozotocin,STZ）法建立 DN 大鼠模型,周期12周。实验12周末检测大鼠血糖、Scr、BUN、24 h 尿蛋白定量;光镜及电镜下观察大鼠肾组织病理改变;采用免疫组化方法检测大鼠肾组织 p - JAK2、p - STAT3、VEGF 表达。结果：实验12周末,模型组大鼠血糖、Scr、BUN、24 h 尿蛋白定量均高于对照组（P ﹤0．05）,肾组织中 p - JAK2、p - STAT3、VEGF 表达均高于对照组（P ﹤0．05）;氯沙坦钾组大鼠 Scr、BUN、24 h 尿蛋白定量均低于模型组（P ﹤0．05）,肾组织 p - JAK2、p -STAT3、VEGF 表达均低于模型组（P ﹤0．05）。结论：氯沙坦钾可能部分通过调控 p - JAK2、p - STAT3及 VEGF 的表达而发挥肾脏保护作用。     

氯沙坦对糖尿病大鼠肾小管间质血管内皮生长因子和CD68表达的影响

目的：研究血管紧张素Ⅱ1型受体拮抗剂（AT1RA）－氯沙坦对链脲佐菌素（STZ）大鼠肾小管间质血管内皮生长因子（VEGF）和CD68表达的影响。方法：用Wistar大鼠建立STZ诱导的糖尿病（DM）模型，设正常对照组（C）、糖尿病组（D）和糖尿病＋氯沙坦治疗组（DA）。用免疫组化方法观察肾小管间质VEGF和CD68的变化。结果：VEGF及CD68在DM大鼠肾小管间质部位较对照组显著升高（P＜0．01）。DA组给予氯沙坦治疗可使VEGF及CD68在肾小管间质表达降低。VEGF与CD68在肾小管间质表达呈显著正相关。结论：氯沙坦可降低糖尿病大鼠肾小管间质VEGF和CD68表达，减轻肾小管间质损害。     

氯沙坦对糖尿病肾病大鼠模型炎症反应的抑制作用

糖尿病肾病是糖尿病全身性微血管病变之一，近年来随着研究的深入，发现糖尿病肾病中炎症反应标志物含量明显增高，提示炎症反应参与糖尿病肾病的发病机制。ARB类药物具有阻断肾素一血管紧张素系统而发挥肾脏保护作用，本实验建立糖尿病肾病模型，观察氯沙坦干预对炎症因子血浆C反应蛋白（c—reactive protein，CRP）、肿瘤坏死因子-α（tumuor necrosisfactor—α，TNF—α）水平的影响，探讨是否通过抑制炎症反应而延缓糖尿病肾病损伤，为其临床进一步应用提供理论依据。     

苯那普利、氯沙坦对糖尿病肾病大鼠Nephrin表达的影响

目的 探讨苯那普利、氯沙坦对糖尿病肾病大鼠Nephrin蛋白表达的影响。方法 建立糖尿病大鼠模型,分别使用苯那普利、氯沙坦治疗及联合治疗4、8周后,取出肾脏,采用逆转录聚合酶链式反应（RTPCR）检测肾皮质Nephrin mRNA的表达。结果 与对照组相比,糖尿病组Nephrin mRNA表达下调,苯那普利、氯沙坦治疗组较糖尿病组表达增加,两者联合治疗后增加更为明显。结论 苯那普利和氯沙坦联合应用,可以完全阻断血管紧张素Ⅱ（AngⅡ）,从而使Nephrin mRNA表达上调;肾小球足细胞损伤明显减轻、蛋白尿明显减少。     

肝细胞生长因子对大鼠颌下腺细胞增殖的影响

目的　研究肝细胞生长因子 (HGF)对体外培养大鼠颌下腺细胞增殖的剂量 效应及时间 效应。方法　采用体外颌下腺细胞培养在含 1 0 %胎牛血清的合成培养液 (DMEM) ,实验组分别加入不同浓度的HGF ,利用噻唑蓝 (MTT)比色法检测细胞的增殖能力 ,研究HGF对颌下腺细胞增殖的影响。结果　在 1 0 %胎牛血清配制的DMEM含HGF(1 .0～ 1 0 0 0 .0 μg/L)可促进培养细胞的增殖 (P <0 .0 1 ) ,且在一定浓度范围内HGF(1 .0、5 .0、1 0 .0、50 .0、1 0 0 .0 μg/L)呈剂量 效应关系 ,最大效应剂量为 1 0 0 .0 μg/L。加入HGF第 3天开始显示出明显的促增殖效应。 结论　HGF在 1 0 %胎牛血清DMEM培养条件下能够促进颌下腺细胞的增殖和分化 ,经体外条件培养的颌下腺细胞可以作为组织工程学研究中的细胞来源     

氨氯地平对糖尿病肾病患者血浆内皮素1水平的影响

内皮素1(ET-1)与糖尿病肾病(DN)的发病相关.我们观察氨氯地平对DN患者血浆ET-1水平的影响,探讨其降压外的肾保护作用机制. 一、对象与方法 1.对象与分组:入选DN患者均符合WH01999糖尿病诊断标准,尿白蛋白排泄率(UAER)大于30 mg/24 h,Scr＜133μmol/L.近3个月,曾发生低血糖或糖尿病酮症酸中毒;急性心脑血管病变,肺部疾患及有手术外伤史;并发原发性慢性肾小球肾炎和其他继发性肾炎;并发原发性高血压、恶性肿瘤、急慢性感染等患者被排除.所有患者入组后均给予常规治疗8周:应用降糖药和(或)胰岛素使糖化血红蛋白(HbA1c)＜6.0;均使用血管紧张素转化酶抑制剂(ACEI)或血管紧张素Ⅱ受体阻滞剂(ARB)及他汀类药物;伴高血压单用ACEI和(或)ARB控制不佳者加用其他非钙通道抑制剂类降压药,使血压＜130/80 mm Hg,胆固醇(TC)＜6.0 mmol/L,三酰甘油(TG)＜1.7 mmol/L.符合条件者共56例,男32例,女24例.     

洛沙坦对糖尿病大鼠肾组织一氧化氮水平的影响

目的 研究洛沙坦对糖尿病大鼠肾组织一氧化氮（NO）水平的影响。方法 雄性Wistar大鼠分为3组,A组（11只）为正常对照组,B组（11只）为糖尿病未干预组,C组（9只）为糖尿病大鼠洛沙坦干预组。以链脲菌素制备糖尿病大鼠模型,大鼠饲养18周后取出肾脏检测诱导型NO合成酶（iNOS）mRNA的表达,电镜检测大鼠肾小球基底膜厚度及系膜基质密度（系膜基质面积/系膜面积）。收集24h尿测定尿白蛋白排泄（UAE）及肌酐,并心脏内取血检测血肌酐。mRNA表达采用RT-PCR,以β-actin作为内对照。UAE测定采用大鼠白蛋白特异的酶免疫分析试剂盒。结果 肾组织iNOSmRNA表达在B组大鼠（0.30±0.12）显著高于A组（0.12±0.04,P<0.01）,C组（0.25±0.14）与B组比较差异无显著性意义（P>0.05）。肾组织NO水平在B组大鼠[（0.56±0.20）μmol/mg肾组织]显著低于A组[（1.05±0.25）μmol/mg肾组织]和C组[（1.13±0.62）μmol/mg肾组织,P均<0.01]。UAE在B组大鼠[（2.18±1.98）mg/d]显著高于A组[（0.41±0.47）mg/d]和C组[（0.65±0.89）mg/d,P均<0.05]。肌酥清除率在B组大鼠[（19.75±9.60）ml/d]显著低于A组[（59.63±22.75）ml/d]和C组[（40.88±25.57）ml/d,P均<0.05]。基底膜厚度在B组大鼠[（531.6±107.6）nm]显著高于A组[（312.4±25     

Regression of advanced diabetic nephropathy by hepatocyte growth factor gene therapy in rats

Diabetic nephropathy is the main cause of end-stage renal disease requiring dialysis in developed countries. In this study, we demonstrated the therapeutic effect of hepatocyte growth factor (HGF) on advanced rather than early diabetic nephropathy using a rat model of streptozotocin-induced diabetes. Early diabetic nephropathy (16 weeks after induction of diabetes) was characterized by albuminuria, hyperfiltration, and glomerular hypertrophy, whereas advanced diabetic nephropathy showed prominent transforming growth factor (TGF)-beta1 upregulation, mesangial expansion, and glomerulosclerosis. An SP1017-formulated human HGF (hHGF) plasmid was administered by intramuscular injection combined with electroporation over a 30-day follow-up in rats with early and advanced diabetic nephropathy. hHGF gene therapy upregulated endogenous rat HGF in the diabetic kidney (rat HGF by RT-PCR was threefold higher than in diabetic rats without therapy). hHGF gene therapy did not improve functional or morphologic abnormalities in early diabetic nephropathy. hHGF gene therapy reduced albuminuria and induced strong regression of mesangial expansion and glomerulosclerosis in advanced diabetic nephropathy. These findings were associated with suppression of renal TGF-beta1 and mesangial connective tissue growth factor (CTGF) upregulation, inhibition of renal tissue inhibitor of metalloproteinase (TIMP)-1 expression, and reduction of renal interstitial myofibroblasts. In conclusion, our results suggest that hHGF gene therapy may be considered as an innovative therapeutic strategy to treat advanced diabetic nephropathy.     

一氧化氮在糖尿病肾病中的作用

目的探讨糖尿病（ＤＭ）和高血压大鼠肾脏一氧化氮（ＮＯ）途径与ＤＭ肾病的关系。方法将自发性高血压大鼠（ＳＨＲ）制成链脲佐菌素（ＳＴＺ）ＤＭ模型。设ＷＫＹ、ＳＨＲ和ＳＨＲＤＭ三组。除形态学观察外,还测定各组大鼠肌酐清除率（Ｃｃｒ）、２４小时尿蛋白、血及肾组织ＮＯ含量、肾脏ＮＯ合成酶（ＮＯＳ）活性和ＮＯＳｍＲＮＡ表达水平。结果ＳＨＲＤＭ组大鼠２４小时尿蛋白定量２０周时明显高于其余两组,Ｃｃｒ无明显改变。血ＮＯ水平升高,肾ＮＯ含量降低。肾脏结构型ＮＯＳ（ｃＮＯＳ）活性下降,诱导型ＮＯＳ（ｉＮＯＳ）活性或ｉＮＯＳ／ｃＮＯＳ（ｉ／ｃ）比值增加。肾小球ＮＯＳｍＲＮＡ表达面积扩大,入球动脉及小叶间动脉ＮＯＳ基因表达明显下降。肾小球系膜增生,有形成ＫＷ结节或纤维蛋白帽的趋势,系膜区基质增多,基底膜增厚,肾小动脉壁厚腔窄。结论（１）ＳＴＺＳＨＲＤＭ模型出现的２４小时尿蛋白增加、肾小球系膜及肾小血管病变提示ＤＭ肾病的产生;（２）肾脏ＮＯ系统异常与ＤＭ肾病有关。     

Intravenous administration of hepatocyte growth factor gene ameliorates diabetic nephropathy in mice

Diabetic nephropathy is characterized by progressive loss of renal function, persistent proteinuria, and relentless accumulation of extracellular matrix leading to glomerulosclerosis and interstitial fibrosis. This study investigated the potential effects of long-term expression of exogenous hepatocyte growth factor (HGF) on normal and diabetic kidneys. Intravenous injection of human HGF gene via naked plasmid vector resulted in abundant HGF protein specifically localized in renal glomeruli, despite an extremely low level of transgene mRNA in the kidney. In uninephrectomized mice made diabetic with streptozotocin, delivery of exogenous HGF gene ameliorated the progression of diabetic nephropathy. HGF attenuated urine albumin and total protein excretion in diabetic mice. Exogenous HGF also mitigated glomerular mesangial expansion, reduced fibronectin and type I collagen deposition, and prevented interstitial myofibroblast activation. In addition, HGF prevented kidney cells from apoptotic death in the glomeruli and tubulointerstitium. Moreover, expression of HGF inhibited renal expression of TGF-beta1 and reduced urine level of TGF-beta1 protein. Therefore, despite the effects of HGF on diabetic nephropathy being controversial, these observations suggest that supplementation of HGF is beneficial in ameliorating diabetic renal insufficiency in mice.     

Role of nitric oxide in diabetic nephropathy

Diabetic nephropathy is the leading cause of end-stage renal disease in the Western hemisphere. Endothelial dysfunction is the central pathophysiologic denominator for all cardiovascular complications of diabetes including nephropathy. Abnormalities of nitric oxide (NO) production modulate renal structure and function in diabetes but, despite the vast literature, major gaps exist in our understanding in this field because the published studies mostly are confusing and contradictory. In this review, we attempt to review the existing literature, discuss the controversies, and reach some general conclusions as to the role of NO production in the diabetic kidney. The complex metabolic milieu in diabetes triggers several pathophysiologic mechanisms that simultaneously stimulate and suppress NO production. The net effect on renal NO production depends on the mechanisms that prevail in a given stage of the disease. Based on the current evidence, it is reasonable to conclude that early nephropathy in diabetes is associated with increased intrarenal NO production mediated primarily by constitutively released NO (endothelial nitric oxide synthase [eNOS] and neuronal nitric oxide synthase [nNOS]). The enhanced NO production may contribute to hyperfiltration and microalbuminuria that characterizes early diabetic nephropathy. On the other hand, a majority of the studies indicate that advanced nephropathy leading to severe proteinuria, declining renal function, and hypertension is associated with a state of progressive NO deficiency. Several factors including hyperglycemia, advanced glycosylation end products, increased oxidant stress, as well as activation of protein kinase C and transforming growth factor (TGF)-beta contribute to decreased NO production and/or availability. These effects are mediated through multiple mechanisms such as glucose quenching, and inhibition and/or posttranslational modification of NOS activity of both endothelial and inducible isoforms. Finally, genetic polymorphisms of the NOS enzyme also may play a role in the NO abnormalities that contribute to the development and progression of diabetic nephropathy.     

糖尿病肾病大鼠不同时期肾小球一氧化氮-血管内皮 生长因子轴的变化特点

糖尿病肾病(DN)时肾小球内一氧化氮(NO)-内皮生长因子(VEGF)轴失衡,且可能对启动DN的发生发展发挥重要作用[1].但目前对DN的肾小球NO-VEGF轴失衡的原因尚不明确.本研究应用DN大鼠模型研究DN不同时期肾小球NO-VEGF轴失衡的原因和特点,探讨影响NO-VEGF轴变化的因素.     

肝细胞生长因子在环孢素A肾病大鼠肾组织中的表达意义

目的　探讨肝细胞生长因子 (HGF)在环孢素A(CsA)肾病大鼠肾组织中的表达及意义。　方法　 2 8只SD大鼠低盐饮食饲养 7d后 ,随机分为对照组、CsA组、CsA加维拉帕米组、CsA加依那普利组。每组 7只。除对照组外 ,其余 3组大鼠皮下注射CsA 15mg·kg-1·d-1,采用放射免疫法检测各组动物血管紧张素Ⅱ (AngⅡ )水平 ;Northernblot、原位杂交检测肾组织HGFmRNA的表达。对各组动物肾小管损伤进行半定量计分。　结果　CsA处理组肾组织AngⅡ水平均明显高于对照组 :(2 9.8± 6.0 )vs (8.7± 1.7)ng/g肾组织 ,P <0 .0 0 1,HGFmRNA表达也明显减少。依那普利组肾组织AngⅡ水平明显降低 ,HGFmRNA表达增加 ,P <0 .0 5。依那普利能明显减轻CsA引起的肾小管损伤 ,异博定对肾小管损伤无显著改善。肾组织HGFmRNA表达与肾小管损伤呈负相关 ,P <0 .0 5。　结论　肾素血管紧张素系统 (RAS)的激活使HGFmRNA表达下调 ,阻断RAS可以使HGFmRNA表达增加 ,减轻CsA引起的肾小管损伤     

氯沙坦对糖尿病肾病患者尿足细胞排泄的影响

目的 观测糖尿病肾病(DN)患者尿足细胞排泄特征及氯沙坦对其的干预作用。方法 前瞻性研究入选30例2型DN患者，经6周洗脱期后给予氯沙坦50 mg/d×8周，继以氯沙坦100 mg/d×8周治疗。10例健康志愿者作为正常对照。采用间接免疫荧光镜检法检测单克隆抗体podocalyxin标记的尿足细胞。结果 DN患者组尿脱落足细胞明显多于对照组。氯沙坦可以显著减少糖尿病肾病患者尿足细胞脱落排泄，但未观测到大剂量氯沙坦比小剂量具有更好的保护作用。糖尿病肾病患者尿足细胞排泄计数与系统血压、尿蛋白量无显著相关。30例糖尿病肾病患者CKD2期组(21例)比CKD3期组(9例)尿足细胞排泄计数显著增多。经治疗后CKD2期组尿足细胞排泄明显减少；CKD3期组无明显变化。结论 尿脱落足细胞可能是预测糖尿病肾病进展的早期有效因子，氯沙坦对糖尿病肾病患者尿足细胞起重要的保护作用。     

Effect of hepatocyte growth factor on tacrolimus-induced nephrotoxicity in spontaneously hypertensive rats

Renal toxicity is a serious side effect of therapy with tacrolimus (FK506), an immunosuppressive agent administered to renal transplant recipients. We investigated the effect of hepatocyte growth factor (HGF) on tacrolimus-induced nephrotoxicity in spontaneously hypertensive rats (SHR). After a right nephrectomy, rats received a continuous perfusion of either HGF in a dose of 5 μg/kg daily (tacrolimus + HGF group) or normal saline (tacrolimus group) into the left renal artery at a rate of 1 μl/h for 7 days after surgery. Tacrolimus was injected intramuscularly in a dose of 4 mg/kg daily for 10 days after surgery. HGF significantly inhibited the tacrolimus-induced increase in the serum creatinine (SCr) level (P < 0.05). HGF also prevented the tacrolimus-induced loss in body weight. The bromodeoxyuridine (BrdU) index was significantly higher in kidney specimens from the tacrolimus + HGF group. These findings suggest that HGF induces the regeneration of renal tubular cells and suppresses tacrolimus-induced renal toxicity in SHR. Received: 26 February 1998 Received after revision: 25 August 1998 Accepted: 23 September 1998