胰岛素治疗方案与糖尿病家兔肾脏病变关系的实验研究  

Experimental study on the relationship between insulin treatment and diabetic rabbit kidney disease

作　　者：李妮[1] 钟玫[1] 陈晖[1] 莫祥兰[1] 周微雅[1] 陈翠玲[1] 黄莹[1] 

机构地区：[1]广西壮族自治区人民医院内分泌科,南宁530021

出　　处：《中国临床新医学》2010年第11期1042-1046,共5页CHINESE JOURNAL OF NEW CLINICAL MEDICINE

基　　金：广西壮族自治区科技厅自然科学基金资助项目(编号:桂科基0385005)

摘　　要：目的以糖尿病家兔肾脏组织、细胞外基质的改变和炎症因子表达为判断标准,探讨模型胰岛素(Ins)用药治疗的适宜方案。方法雄性家兔40只,随机分成对照组(N组)、糖尿病模型组(D组)、多次Ins治疗组(A组)、50R混合Ins治疗组(B组)、30R混合Ins治疗组(C组)。治疗组用Ins治疗30d后处死动物,同时处死其他组动物;观察各治疗组血糖达标时间及达标时Ins用量。比较各组血糖、糖化血红蛋白(HbAlc)、白天平均血糖水平(MBG)、血糖标准差平均值(MOS)、每只兔血糖绝对差值的平均值(MODD)、肿瘤坏死因子-α(TNF-α)、细胞外基质部分成分(ECM)、NF-κB的表达情况。结果 A组达标时间最短,C组最长(P<0.01)。治疗各组血糖和HbAlc较D组下降(P<0.05)。A、D两组较C、N两组NF-κB灰度值明显降低,TNF-α、ECM明显升高(P<0.05)。A组的MOS、MODD较C组和N组明显升高(P<0.001);HbAlc与MBG呈正相关(P<0.001),与MOS、MODD无相关。D组血糖及NF-κB灰度值与TNF-α呈正相关(P均<0.02)。肾脏组织病变受损严重程度及炎症因子表达明显度D组>A组>B组>C组。结论 30R预混胰岛素治疗方案最佳。提供一个较高的基础胰岛素浓度加少量餐时胰岛素峰值量治疗糖尿病,血糖平稳缓降,对糖尿病肾组织有治疗和保护作用。多次胰岛素3短加1中或长的强化治疗及太短时间达标的方法不主张首选。Objective To investigate the optimal insulin regimens in rabbit diabetes mellitus model according to changes of the ncphridial tissue, expression of the inflammatory factors and the components of extracellular matrix（ECM） in kidney. Methods Fourty male rabbits were randomly divided into N group; D group （diabetes mellitus model group） ; A group received multiple injection of insulin; B group pre-mixed 50R; C group pre-mixed 30R. The animals of treated groups with insulin therapy were sacrificed 30 days later. The animals of other groups were sacrificed at the same time. The insulin dose and period at the targeted blood glucose level among 3 insulin groups was recorded. The blood glucose levels, HbAlc, daytime mean blood glucose（MBG）, blood glucose mean of standard deviation （MOS）, each rabbit blood glucose mean of definite difference（ MODD）, NW, TNF-α, CIV, LN, PCⅢ were observed and the expression of NF-KB in the nephridial tissue analysed. Results The period was longest and the amount of insulin was the largest in C group at the targeted blood glucose level（ P 〈 0. 01 ）. The NF-KB gradation value of D group and A group were significantly lower, and TNF-α, CIV, LN, PC Ⅲ of D group and A group were markedly higher than those of C and N group （P 〈 0. 05）. MOS and MODD were significantly higher in A group than those in C and N groups （P 〈 0. 001 ） ; HbAlc was positively correlated with MBG （P 〈 0. 001 ）. However, it was non-related with MOS and MODD. The blood glucose were negatively related to the NF-KB gradation value ;were positively related to TNF-α（P 〈 0.02） in D group. The severity damage on kidney and expression of the inflammatory factors in modle group and every treated group were D 〉 A 〉 B 〉 C. Conclusion Pre-mixed 30R may be the optimal insulin treatment protocols. Insulin therapy by multiple injection and reaching the target blood glucose quickly should not be used as a primary regimen.

关 键 词：糖尿病家兔模型 肾组织病理 核因子-KB 肿瘤坏死因子-Α 细胞外基质 

分 类 号：R587.1[医药卫生—内分泌]