胃转流术对2型糖尿病大鼠肾脏的保护作用及其机制探讨  

Renal protection effect of gastric bypass and its mechanism in type 2 diabetes mellitus rats

作　　者：陈振宇[1] 文艺[1] 张少华[1] 冯犁[1] 闫洪涛[1] 邹洪[1] 汤礼军[1] 

机构地区：[1]成都军区成都总医院全军普通外科中心,成都610083

出　　处：《解放军医学杂志》2014年第6期454-458,共5页Medical Journal of Chinese People's Liberation Army

基　　金：全军临床高新技术重大项目(2010gxjs040)~~

摘　　要：目的观察胃转流术对2型糖尿病(T2DM)大鼠肾脏的保护作用,并探讨其可能机制。方法 40只SD大鼠随机分为正常对照组(n=8)和糖尿病模型组(n=32),模型组注射STZ(35mg/kg),血糖稳定后确定成模30只,再将其分为糖尿病对照组(n=8)、假手术组(n=8)、手术组(n=14)。手术组大鼠行Roux-en-Y胃转流术。术后8周检测各组大鼠空腹血糖、肾重指数(肾重/体重)、尿素氮(BUN)、血肌酐(Cr)水平,肾组织总超氧化物歧化酶(TSOD)、谷胱甘肽过氧化酶(GSH-PX)活性及脂质过氧化代谢产物丙二醛(MDA)含量,肾组织醛糖还原酶(AR)活性及AR mRNA的表达,并行HE染色观察肾组织病理变化。结果与正常对照组比较,糖尿病对照组和假手术组大鼠空腹血糖、肾重指数明显升高,肾功能相关指标BUN、Cr亦显著升高(P<0.05),肾组织TSOD、GSH-PX活性低下,MDA含量增加(P<0.05),肾脏AR活性增强,AR mRNA表达增加(P<0.05)。与糖尿病对照组和假手术组相比,手术组大鼠空腹血糖、肾重指数、BUN、Cr均明显降低(P<0.05),同时肾组织TSOD、GSH-PX活性增强,MDA含量减少(P<0.05),肾脏AR活性降低,AR mRNA表达下调(P<0.05)。HE染色显示正常对照组肾组织病理结构无异常,糖尿病对照组和假手术组肾小球明显增大,系膜明显增生,系膜区扩张,手术组病变明显轻于糖尿病对照组和假手术组。结论胃转流术可能通过减轻肾脏氧化应激损伤,抑制肾脏AR活性及AR mRNA表达而抑制多元醇通路的过度激活,从而发挥肾脏保护作用。Objective To observe the renal protection effect of gastric bypass, and explore its possible mechanism in type 2 diabetes mellitus （T2DM） rats. Methods Forty SD rats were randomly divided into normal control group （n=8） and diabetes model group （n=32）. Rats in diabetes model group were injected STZ （35 mg/kg）. After the diabetes model was reproduced successfully, they were randomly divided into diabetes control group （n=8）, diabetes sham-operation group （n=8） and diabetes operation group （n-=14）. Roux-en-Y gastric bypass was performed in rats of diabetes operation group. The fasting blood glucose （FBG）, renal hypertrophy index （kidney weight/body weight）, blood urea nitrogen （BUN）, serum creatinine （Cr）, activity of total superoxide dismutase （TSOD） and glutathione peroxidase （GSH-PX）, content of malondialdehyde （MDA）, activity of aldose reductase （AR） and AR mRNA expression in the kidney were determined 8 weeks after operation. The renal tissue was examined with light microscopy. Results Compared with normal control group, the renal hypertrophy index, FBG, BUN, Cr, content of MDA, activity of AR and AR mRNA expression in the kidney significantly increased in diabetes control group and diabetes sham-operation group, while the activity of TSOD and GSH-PX decreased （P〈0.05）. Compared with diabetes control group and diabetes sham operation group, the kidney hypertrophy index, FBG, BUN, Cr, content of MDA, activity of AR and AR mRNA expression in diabetes operation group markedly decreased （P〈0.05）, while the activity of TSOD and GSH-PX increased （P〈0.05）. HE staining showed that the renal structure was normal in normal control group. The glomeruli became obviously enlarged, mesangial proliferation was marked, and the mesangial zone expanded in diabetes control group and diabetes sham-operation group. Such renal changes appeared milder in diabetes operation group. Conclusion The gastric bypass could protect the kidney of T2DM rats, which ma

关 键 词：糖尿病 2型 胃转流术 肾功能 醛还原酶 

分 类 号：R656.6[医药卫生—外科学] R587.1[医药卫生—临床医学]