不同取穴不同灸时温和灸对局灶硬化性肾炎大鼠肾功能的影响

目的:观察不同取穴不同灸时温和灸对局灶硬化性肾炎大鼠尿系列微量蛋白及肾组织病理变化的影响,探讨艾灸治疗局灶硬化性肾炎的作用机制。方法:SD大鼠随机分为正常组、假手术组、模型组、氯沙坦组、肾俞灸法(短时、中时、长时)组和膈俞灸法(短时、中时、长时)组,通过单肾切除加尾静脉重复注射阿霉素复制局灶硬化性肾炎大鼠模型。氯沙坦组给予氯沙坦(50mg/kg)灌胃,每日1次;肾俞灸法组和膈俞灸法组按短时(10min)、中时(20min)、长时(30min),分别予温和灸大鼠"肾俞"(双)和"膈俞"(双),隔日1次,均干预12周。酶联免疫法检测各组大鼠尿系列微量蛋白(尿α1微球蛋白、尿微量白蛋白、尿转铁蛋白、尿IgG),全自动生化分析仪测定肾功能(血清肌酐、尿素氮、尿酸),PAS染色法观察肾组织病理学改变。结果:模型组尿系列微量蛋白、血清肌酐、尿素氮、尿酸明显高于假手术组及正常组(P0.01);与模型组比较,氯沙坦组、肾俞长时组、膈俞中时组、膈俞长时组尿系列微量蛋白和血肌酐、尿素氮、尿酸均显著降低(P0.05,P0.01),肾俞中时组的尿α1微球蛋白、尿微量白蛋白、尿IgG、血肌酐、尿素氮降低(P0.05,P0.01)。不同灸时之间比较,肾俞长时组的尿系列微量蛋白及膈俞长时组的尿α1微球蛋白、尿转铁蛋白、尿IgG较同一穴位短时组明显下降(P0.05,P0.01)。模型组可见肾小球系膜细胞增生,大量胶原蛋白沉积,间质纤维化明显;肾俞长时组、膈俞长时组及氯沙坦组可明显改善病理变化。结论:艾灸"肾俞"穴、"膈俞"穴可以改善局灶硬化性肾炎模型大鼠的蛋白尿及肾功能,从而延缓病程进展,适当地延长艾灸时间保证灸量,治疗效果更佳。

Effect of Mild Moxibustion with Different Terms at Different Acupoints on Renal Functions and Renal Pathological Changes in Focal Segmental Glomerulosclerosis Rats

Objective To observe changes of urinary microprotein,and serum creatinine,urea nitrogen and uric acid levels in focal segmental glomerulosclerosis(FSGS)rats treated by mild moxibustion,so as to explore the mechanism of moxibustion underlying improvement of FSGS.Methods SD rats were randomized into normal control(normal),sham operation(sham),model,medication(Losartan),moxibustion-Shenshu(BL 23)and moxibustion-Geshu(BL 17)groups.The latter two moxibustion groups were further divided into 10 min,20min and 30 min subgroups(n=6in each group/subgroups).The FSGS model was established by unilateral nephrectomy combined with injection of Losartan into the tail vein twice.Mild moxibustion was applied to bilateral BL 17 and BL 23 for 10,20 and 30min,respectively,once every other day,for 12 weeks.The contents of urinary microglobulinα1,micro-albumin,transferring and IgG were assayed using enzyme linked immunosorbent assay(ELISA),and serum creatinine,urea nitrogen and uric acid contents(indexes of renal function)determined using an automatic biochemical analyzer.The pathological changes of the kidney tissue was observed by using a microscope after periodic acid schiff(PAS)staining.Results No significant differences were found between the normal control and sham groups in the levels of all the urinary and serum indexes(P>0.05)and pathological changes of the renal tissues.Compared with the normal control group,the contents of urinary microglobulinα1,micro-albumin,transferrin and IgG,and serum creatinine,urea nitrogen and uric acid were significantly increased in the model group(P<0.01).Following medication and moxibustion,the contents of the aforementioned 7indexes in the Losartan group,and urinary microglobulinα1,micro-albumin,transferrin and IgG,and serum creatinine levels in the moxibustion BL 23-20 min and 30 min groups,and the micro-albumin and transferrin contents in the BL-17 10 min group and IgG level in the BL-23 10 min group,the serum creatinine and urea nitrogen levels at the 3time-points of both moxibustion BL 23 and BL 17 groups,and serum uric acid in the moxibustion BL 23 30 min,and BL17 20 and 30min groups were all considerably downregulated(P<0.05,P<0.01).The therapeutic effects of moxibustion 30 min were notably better than moxibustion 10 min in reducing urinary microglobulinα1,micro-albumin,transferring and IgG levels(P<0.05,P<0.01).Results of PAS staining showed that the injury of the renal tissue as the endothelial and mesangial cellular proliferation,collagen proteinosis,interstitial fibrosis,etc were relatively milder in the Losartan and moxibustion 20 and 30min groups.Conclusion Mild moxibustion may reduce proteinuria,and improve the kidney function and pathological changes in FSGS rats,and longer duration of moxibustion is better in achieving therapeutic effect.