不同目标血糖管理对脓毒症大鼠肝脏损伤的影响  

Effect of different targets of glucose control on liver damage in rats with sepsis

作　　者：曾建琼[1] 程青虹[1] 何永来[1] 齐研[1] 

机构地区：[1]石河子大学第一附属医院重症医学二科,新疆维吾尔自治区石河子市832000

出　　处：《中国感染与化疗杂志》2015年第5期479-484,共6页Chinese Journal of Infection and Chemotherapy

摘　　要：目的：探讨胰岛素控制不同目标血糖水平对脓毒症大鼠肝脏损伤的影响及相关机制。方法40只SD大鼠随机分为5组：假手术组、脓毒症组和血糖控制水平由低到高的A组、B组、C组，每组各8只。盲肠结扎穿孔术后12 h处死，处死动物后取静脉血检测血清丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）和游离脂肪酸（FFA）水平，免疫组化测定肝组织过氧化物酶体增殖物激活受体α（PPAR‐α）及肉毒碱棕榈酰基转移酶1（CPT‐1）表达水平，光镜观察肝组织病理切片。结果①脓毒症组血清ALT、AST、FFA及肝脏病理评分明显高于假手术组和各血糖控制组（P＜0．05），A组较B、C组明显降低（P＜0．05）， B组低于C组（P＜0．05）；②脓毒症组肝组织CPT‐1及PPAR‐α的表达明显低于各血糖控制组及假手术组，但与C组差异无统计学意义（P＞0．05），A组较B、C组明显增高（P＜0．05），B组高于C组（P＜0．05）。结论血糖控制为4．4～6．1 mmol／L对脓毒症大鼠肝脏损伤保护作用最明显，其机制可能与上调肝脏PPAR‐α及CPT‐1的表达有关。Objective To examine the effect and mechanism of different targets of glucose control on liver damage in rats with sepsis .Methods The rat sepsis model was established by cecal ligation and puncture （CLP） .Forty Sprague‐Dawley rats were randomly divided into five groups （eight rats to each group）：sham operation （sham group） ,sepsis （CLP group） ,glycemic control A group （glucose target 4 .6‐6 .1 mmol/L ） ,glycemic control B group （glucose target 6 .2‐8 .3 mmol/L ） and glycemic control C group （glucose target 8 .4‐10 .0 mmol/L） .The animals were sacrificed 12 hours after CLP .Venous blood was sampled for testing alanine transaminase （ALT ） , aspartate transaminase （AST ） and free fatty acid （FFA ） . Peroxisome proliferator activated receptor‐α （PPAR‐α） and liver carnitine palmitoyltransferase 1 （CPT‐1 ） protein were determined by immunohistochemistry .The pathological changes of liver tissue was observed under an optical microscope .Results The levels of ALT ,AST and FFA in venous blood and the pathological tissue injury score in sepsis groups were higher than those in sham group and all glycemic control groups （P＆lt;0 .05） .However ,the level of these markers significantly decreased in group A than those in group B or group C （P＆lt;0 .05） ,and lower in group B than those in group C （P＆lt; 0 .05） .PPARα and liver CPT‐1 expression levels were lower in sepsis group than those in sham group and all glycemic control groups except group C （P＆gt;0 .05） .The levels of PPARαand liver CPT‐1 were significantly higher in group A than in group B or group C （P＆lt;0 .05） ,and lower in group C than in group B（P＆lt;0 .05） .Conclusions The lowest target of glucose control（4 .6‐6 .1 mmol/L）shows better protective effects on liver damage in rats with sepsis ,the mechanism of which may be related to upregulation of PPARα and liver CPT‐1 expression .

关 键 词：脓毒症 目标血糖管理 过氧化物酶体增殖物激活受体Α 肉毒碱棕榈酰基转移酶1 大鼠 

分 类 号：R459.7[医药卫生—急诊医学]