外源性胰岛素对重症急性胰腺炎大鼠相对肾上腺功能不全的保护作用研究  

Protective effect of exogenous insulin on relative adrenal insufficiency in rats with severe acute pancreatitis

作　　者：赵亮[1,2] 梅方超 周瑜[1,2] 李满 王卫星[1,2] 余佳 邓文宏[1,2,3] ZHAO Liang;MEI Fangchao;ZHOU Yu;LI Man;WANG Weixing;YU Jia;DENG Wenhong(Department of General Surgery,Renmin Hospital of Wuhan University,Wuhan 430060,P.R.China;Hubei Key Laboratory of Digestive System Disease,Wuhan 430060,P.R.China;Central Laboratory,Renmin Hospital of Wuhan University,Wuhan 430060,P.R.China)

机构地区：[1]武汉大学人民医院普通外科,武汉430060 [2]消化系统疾病湖北省重点实验室,武汉430060 [3]武汉大学人民医院中心实验室,武汉430060

出　　处：《中国普外基础与临床杂志》2021年第6期721-726,共6页Chinese Journal of Bases and Clinics In General Surgery

基　　金：国家自然科学基金项目(项目编号:81500488);武汉中青年医学骨干人才培养工程项目[项目编号:武卫通(2019)87号]。

摘　　要：目的探讨外源性胰岛素对重症急性胰腺炎(SAP)大鼠相对肾上腺功能不全(RAI)的保护作用。方法80只SPF级SD大鼠,随机均分为5组(n=16),即假手术(SO)组、SAP组、低剂量胰岛素干预组(低剂量组,0.05 U/100 g体质量)、中剂量胰岛素干预组(中剂量组,0.1 U/100 g体质量)和高剂量胰岛素干预组(高剂量组,0.2 U/100 g体质量);以上5组均再随机分成2个亚组即二十四肽促皮质素试验(CST)亚组和非CST亚组。采用5%牛磺胆酸钠胆胰管逆行注射建立SAP大鼠模型。建模后3 h处死大鼠,用全自动生化仪检测大鼠血清淀粉酶(AMY)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、尿素(Ur)和肌酐(Cr)水平,ELISA试剂盒检测血清肿瘤坏死因子-α(TNF-α)和皮质酮(Cor)水平。光镜下观察大鼠胰腺及肾上腺组织的病理改变。油红O染色观察肾上腺的脂质含量。结果与SO组比较,SAP组大鼠血清AMY、ALT、AST、Ur、Cr、TNF-α和Cor水平均显著升高(P<0.05),胰腺和肾上腺出现典型病理损伤,病理评分均显著升高(P<0.05)。与SAP组比较,低剂量组的AMY、ALT、AST、Ur、Cr、TNF-α和Cor水平无显著改变(P>0.05);中剂量组和高剂量组的AMY、ALT、AST、Ur、Cr和TNF-α水平均显著降低(P<0.05),Cor水平显著升高(P<0.05);与低剂量组比较,中剂量和高剂量组AMY、ALT、AST、Cr、TNF-α显著降低(P<0.05),Cor水平显著升高(P<0.05),Ur水平无显著变化。中剂量和高剂量组的AMY、ALT、AST、Ur、Cr、TNF-α和Cor水平差异无统计学意义(P>0.05)。CST干预后,SAP组和低剂量组血清Cor水平无显著改变(P>0.05),而SO组、中剂量和高剂量组血清Cor水平显著升高(P<0.05)。结论合适剂量的外源性胰岛素可改善SAP相关肾上腺损伤和RAI,但其具体机制仍需进一步研究阐明。Objective To investigate the protective effect of exogenous insulin on relative adrenal insufficiency(RAI)in rats with severe acute pancreatitis(SAP).Methods Eighty SPF SD rats were randomly divided into 5 groups(n=16):sham operation(SO)group,SAP group,low-dose insulin intervention(low-dose)group(0.05 U/100 g body weight),medium-dose insulin intervention(medium-dose)group(0.1 U/100 g body weight),and high-dose insulin intervention(high-dose)group(0.2 U/100 g body weight).The five groups were randomly divided into two subgroups:cosyntropin stimulation test(CST)subgroup and non-CST subgroup.SAP model was established by retrograde injection of 5%sodium taurocholate into biliopancreatic duct.The rats were sacrificed 3 hours after the establishment of SAP model.The levels of amylase(AMY),alanine aminotransferase(ALT),aspartate aminotransferase(AST),urea(Ur)and creatinine(Cr)were detected by automatic biochemical analyzer.The serum levels of tumor necrosis factor-α(TNF-α)and corticosterone(Cor)were detected by ELISA kit.The pathological changes of pancreas and adrenal gland were observed under light microscope.The lipid content of adrenal gland was observed by oil red O staining.Results Compared with the SO group,the serum levels of Amy,ALT,AST,Ur,Cr,TNF-αand Cor in the SAP group were significantly increased(P<0.05),typical pathological damages occurred in pancreas and adrenal gland,and pathological scores were significantly increased(P<0.05).Compared with the SAP group,the levels of AMY,ALT,AST,Ur,Cr,TNF-αand Cor in the low-dose group were not significantly changed(P>0.05);the levels of AMY,ALT,AST,Ur,Cr and TNF-αin the medium-dose group and the high-dose group were significantly decreased(P<0.05),and Cor levels were significantly increased(P<0.05).Compared with the low-dose group,AMY,ALT,AST,Cr,TNF-αin the medium-dose group and the high-dose group were significantly decreased(P<0.05),Cor level were significantly increased(P<0.05),Ur level had no significant change.There were no significant difference in AMY,ALT

关 键 词：重症急性胰腺炎 相对肾上腺功能不全 胰岛素 皮质酮 

分 类 号：R576[医药卫生—消化系统] R586[医药卫生—内科学]