中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2014年
32期
2549-2552
,共4页
脓毒症%盲肠结扎穿孔%下丘脑-垂体-肾上腺轴
膿毒癥%盲腸結扎穿孔%下丘腦-垂體-腎上腺軸
농독증%맹장결찰천공%하구뇌-수체-신상선축
Sepsis%Cecal ligation and puncture%Hypothalamic-pituitary-adrenal axis
目的：探讨血必净注射液（天津红日药业股份有限公司，批号：09072101）对脓毒症大鼠早期下丘脑组织促肾上腺皮质激素释放激素（ CRH ）和血浆促肾上腺皮质激素（ ACTH ）、皮质酮（ CORT）水平的变化以及下丘脑-垂体-肾上腺超微结构的改变，了解其对脓毒症大鼠下丘脑-垂体-肾上腺（ HPA）轴的调节作用。方法选用健康雄性SD 大鼠40只，随机数字表法分为正常对照组（Normal 组），假手术组（Sham 组），生理盐水治疗组（NS组）和血必净治疗组（XBJ 组）4个组，采用经典的盲肠结扎穿孔法（ CLP）制作SD大鼠脓毒症模型。术后6 h处死动物，检测下丘脑组织CRH、ACTH、CORT水平；透射电镜观察各组下丘脑-垂体-肾上腺的超微结构变化。结果 NS组血浆CORT含量（30.66±1.55）ng/ml明显高于Normal 组（7.63±0.56） ng/ml，P＜0.01）及 Sham 组（11.85±0.87）ng/ml，P＜0.01），XBJ组血浆CORT含量（22.13±1.49）ng/ml，明显低于NS组（P＜0.01）， Normal组与Sham组比较差异无统计学意义（P＞0.05）；NS组血浆ACTH含量（26.26±1.63）pg/ml，明显高于Normal组（8.84±1.39）pg/ml，P＜0.01及Sham组（11.43±0.47）pg/ml，P＜0.01，XBJ血浆ACTH含量（18.03±0.75）pg/ml，明显低于NS组（P＜0.01），Normal组与Sham组比较差异无统计学意义（P＞0.05）；NS 组下丘脑组织匀浆中 CRH 含量（101.92±6.61） ng/ml，明显高于 Normal 组（61.65±6.05） ng/ml，P＜0.05和Sham组（66.65±4.04） ng/ml，P＜0.05，XBJ组下丘脑组织CRH含量（84.90±2.51）ng/ml明显低于NS组（P＜0.05），Normal组与Sham组比较差异无统计学意义（P＞0.05）；电镜结果显示：NS组下丘脑粗面内质网囊状扩张、脱颗粒，高尔基复合体肿胀；垂体ACTH细胞分泌颗粒增多；肾上腺组织脂滴耗减。 XBJ组和Sham组下丘脑、垂体、肾上腺病理改变均较NS组为轻。结论脓毒症早期大鼠下丘脑组织CRH和血浆ACTH、CORT的水平明显升高，HPA轴处于过度激活的状态，血必净干预后能够降低下丘脑组织CRH和血浆ACTH、CORT的水平，减轻脓毒症大鼠的过度应激状态。
目的：探討血必淨註射液（天津紅日藥業股份有限公司，批號：09072101）對膿毒癥大鼠早期下丘腦組織促腎上腺皮質激素釋放激素（ CRH ）和血漿促腎上腺皮質激素（ ACTH ）、皮質酮（ CORT）水平的變化以及下丘腦-垂體-腎上腺超微結構的改變，瞭解其對膿毒癥大鼠下丘腦-垂體-腎上腺（ HPA）軸的調節作用。方法選用健康雄性SD 大鼠40隻，隨機數字錶法分為正常對照組（Normal 組），假手術組（Sham 組），生理鹽水治療組（NS組）和血必淨治療組（XBJ 組）4箇組，採用經典的盲腸結扎穿孔法（ CLP）製作SD大鼠膿毒癥模型。術後6 h處死動物，檢測下丘腦組織CRH、ACTH、CORT水平；透射電鏡觀察各組下丘腦-垂體-腎上腺的超微結構變化。結果 NS組血漿CORT含量（30.66±1.55）ng/ml明顯高于Normal 組（7.63±0.56） ng/ml，P＜0.01）及 Sham 組（11.85±0.87）ng/ml，P＜0.01），XBJ組血漿CORT含量（22.13±1.49）ng/ml，明顯低于NS組（P＜0.01）， Normal組與Sham組比較差異無統計學意義（P＞0.05）；NS組血漿ACTH含量（26.26±1.63）pg/ml，明顯高于Normal組（8.84±1.39）pg/ml，P＜0.01及Sham組（11.43±0.47）pg/ml，P＜0.01，XBJ血漿ACTH含量（18.03±0.75）pg/ml，明顯低于NS組（P＜0.01），Normal組與Sham組比較差異無統計學意義（P＞0.05）；NS 組下丘腦組織勻漿中 CRH 含量（101.92±6.61） ng/ml，明顯高于 Normal 組（61.65±6.05） ng/ml，P＜0.05和Sham組（66.65±4.04） ng/ml，P＜0.05，XBJ組下丘腦組織CRH含量（84.90±2.51）ng/ml明顯低于NS組（P＜0.05），Normal組與Sham組比較差異無統計學意義（P＞0.05）；電鏡結果顯示：NS組下丘腦粗麵內質網囊狀擴張、脫顆粒，高爾基複閤體腫脹；垂體ACTH細胞分泌顆粒增多；腎上腺組織脂滴耗減。 XBJ組和Sham組下丘腦、垂體、腎上腺病理改變均較NS組為輕。結論膿毒癥早期大鼠下丘腦組織CRH和血漿ACTH、CORT的水平明顯升高，HPA軸處于過度激活的狀態，血必淨榦預後能夠降低下丘腦組織CRH和血漿ACTH、CORT的水平，減輕膿毒癥大鼠的過度應激狀態。
목적：탐토혈필정주사액（천진홍일약업고빈유한공사，비호：09072101）대농독증대서조기하구뇌조직촉신상선피질격소석방격소（ CRH ）화혈장촉신상선피질격소（ ACTH ）、피질동（ CORT）수평적변화이급하구뇌-수체-신상선초미결구적개변，료해기대농독증대서하구뇌-수체-신상선（ HPA）축적조절작용。방법선용건강웅성SD 대서40지，수궤수자표법분위정상대조조（Normal 조），가수술조（Sham 조），생리염수치료조（NS조）화혈필정치료조（XBJ 조）4개조，채용경전적맹장결찰천공법（ CLP）제작SD대서농독증모형。술후6 h처사동물，검측하구뇌조직CRH、ACTH、CORT수평；투사전경관찰각조하구뇌-수체-신상선적초미결구변화。결과 NS조혈장CORT함량（30.66±1.55）ng/ml명현고우Normal 조（7.63±0.56） ng/ml，P＜0.01）급 Sham 조（11.85±0.87）ng/ml，P＜0.01），XBJ조혈장CORT함량（22.13±1.49）ng/ml，명현저우NS조（P＜0.01）， Normal조여Sham조비교차이무통계학의의（P＞0.05）；NS조혈장ACTH함량（26.26±1.63）pg/ml，명현고우Normal조（8.84±1.39）pg/ml，P＜0.01급Sham조（11.43±0.47）pg/ml，P＜0.01，XBJ혈장ACTH함량（18.03±0.75）pg/ml，명현저우NS조（P＜0.01），Normal조여Sham조비교차이무통계학의의（P＞0.05）；NS 조하구뇌조직균장중 CRH 함량（101.92±6.61） ng/ml，명현고우 Normal 조（61.65±6.05） ng/ml，P＜0.05화Sham조（66.65±4.04） ng/ml，P＜0.05，XBJ조하구뇌조직CRH함량（84.90±2.51）ng/ml명현저우NS조（P＜0.05），Normal조여Sham조비교차이무통계학의의（P＞0.05）；전경결과현시：NS조하구뇌조면내질망낭상확장、탈과립，고이기복합체종창；수체ACTH세포분비과립증다；신상선조직지적모감。 XBJ조화Sham조하구뇌、수체、신상선병리개변균교NS조위경。결론농독증조기대서하구뇌조직CRH화혈장ACTH、CORT적수평명현승고，HPA축처우과도격활적상태，혈필정간예후능구강저하구뇌조직CRH화혈장ACTH、CORT적수평，감경농독증대서적과도응격상태。
Objective To explore the levels of corticotropin-releasing hormone ( CRH ) , adrenocorticotropic hormone ( ACTH ) , cortisone ( CORT ) and ultrastructural abnormalities in hypothalamus, pituitary, adrenal specimens and potential effects of Xuebijing injection in septic rats . Methods Sepsis was induced in adult male Sprague-Dawley rats by cecal ligation and puncture ( CLP).A total of 40 rats were randomly divided into control group ( n=10 ) , sham-operated group ( n=10 ) , saline treatment group (NS, 4 ml/kg, n=10), Xuebijing injection treatment group (XBJ, 4 ml/kg, n=10).The histological abnormalities associated with sepsis were examined in hypothalamus , pituitary and adrenals.Radioimmunoassay ( RIA) was used to detect the levels of CRH in hypothalamic tissue and the plasma levels of ACTH and CORT.Results Compared with normal control or sham group , the levels of CRH in hypothalamus tissue of CLP group and plasma levels of ACTH and CORT increased in early stage of sepsis .In NS group, the plasma CORT concentration ((30.66 ±1.55) ng/ml) was significantly higher than that in normal control group ((7.63 ±0.56) ng/ml, P<0.01) and sham group ((11.85 ±0.87) ng/ml, P<0.01).In XBJ group, the plasma CORT concentration ((22.13 ±1.49) ng/ml) was significantly lower than that in NS group ( P<0.01 ).There was no significant difference between normal control and sham groups ( P >0.05 ).In NS group , the plasma concentration of ATCH ( ( 26.26 ±1.63 ) pg/ml ) was significantly higher than that in normal control group ((8.84 ±1.39) pg/ml, P<0.01) and sham group ((11.43 ±0.47) pg/ml, P<0.01).In XBJ group, the plasma concentration of ATCH ((22.13 ±1.49) ng/ml) was significantly lower than that in NS group (P<0.01).No significant difference existed between normal control and sham groups ( P >0.05 ).In NS group , the level of CRH in hypothalamus tissue ((101.92 ±6.61) ng/ml) was significantly higher than that in normal control group ((61.65 ±6.05) ng/ml, P<0.05) and sham group ((66.65 ±4.04) ng/ml, P<0.05).In XBJ group, the concentration of CRH in hypothalamus tissue ((84.90 ±2.54) ng/ml) was significantly lower than that in NS group (P<0.05).There was no significant difference between normal control and sham groups ( P >0.05 ).The ultrastructures of hypothalamus , pituitary and adrenal changed.In CLP group , the ultrastructure of hypothalamus was as follows: rough endoplasmic reticulum expanded.There were degranulation and Golgi complex swelling.A large number of endocrine granules could be seen in ATCH cells in pituitary and a depletion of adrenal lipid droplets .Conclusion Xuebijing injection can lessen the excessive activated status of hypothalamic-pituitary-adrenal axis .
