论文标题:实验性大鼠糖尿病肾病及“糖肾康”的预防作用
The evaluation of therapeutic effects of TongBiLing on treating ankylosing spondylitis
论文作者 苏宁
论文导师 连至诚,论文学位 硕士,论文专业 中西医结合基础
论文单位 广州中医药大学,点击次数 674,论文页数 60页File Size2580k
2001-04-01论文网 http://www.lw23.com/lunwen_284317/ 糖肾康,大鼠,糖尿病肾病,预防
Tang Shen Kang,Rat,Diabetic Nephropathy,prevent
糖尿病肾病（Diabetic Nephropathy，DN）是指糖尿病时发生的肾小球、肾小管、肾间质和肾血管病变。是糖尿病临床较为严重的心脑肾三大合并症之一，直接影响着糖尿病预后。在DN的进程中，肾小球首先出现高灌流、高滤过状态，病理方面，早期可见肾单位肥大和肾小球高灌注的改变，以后随着病程进展逐渐出现肾小球、肾小管、间质和血管的病变。动物实验也发现，糖尿病实验动物肾脏肥大，弥漫性和渗出性肾小球病变，肾小球基底膜（GBM）增厚，系膜基质扩张和系膜细胞增生，PAS染色中这些物质呈现阳性结果。继而肾小球滤过率（GFR）开始下降，尿白蛋白逐渐增高，最后肾功能衰竭。 现代医学治疗糖尿病肾病主要着眼于降糖、降压对症处理。而中西医结合，通过辨证论治，开发中药方剂，结合西药的降压、改善微循环，标本兼治，达到了预防和治疗并重，切实改善了糖尿病患者的肾功能，延长了病尿病患者的生存时间。本研究旨在了解大鼠糖尿病肾病的组织学改变和临床进程的关系，并通过中药复方“糖肾康”进行预防性治疗，以期延缓或阻止糖尿病肾病的发生。 本实验利用腹腔注射链脲佐菌素（STZ）造成SD大鼠糖尿病模型，将动物分组处理，设立了糖肾康治疗组、优降糖加依那普利阳性治疗对照组、糖尿病模型非治疗对照组和正常对照组。在糖尿病模型组90％以上大鼠出现尿蛋白阳性时，中止实验。全部大鼠测血糖、尿糖及尿蛋 实验性大鼠糟尿病肾病及啪肾康”的预防作用白，取肾脏观察形态学变化并在图像分析仪上测量肾小球的面积、毛细血管球的面积及PAS染色阳性物质的面积。计算肾小球及毛细胞血管球增大的比例、PAS阳性物质占毛细血管球的比例。利用统计学方法计算各组动物以上各项数据的均数和标准差，并进行方差分析。结果表明“糖肾康”治疗组与西药对照组、模型对照组比较，血糖、尿糖、体重均没有显著差别，但尿蛋白有显著差别，糖肾康组的尿蛋白明显低于模型对照组和西药对照组。显微镜下也观察到糖肾康组肾小管腔内蛋白性物质的比例较低。各组肾小球都有增大表现，组间方差分析P＜0刀5，糖肾康组肾小球增大的数值最小。毛细血管丛都普遍增大，但组间方差分析P＞0．05，各组间没有统计学意义。P＊S阳性物质的测量，各组间方差分析P＜o．05，糖肾康组P＊S阳性物质量最少。显微镜下也可发现，在增大的肾小球中，模型组及西药组肾脏PAS物质增多及毛细血管管腔扩张均可见到，而糖肾康组主要是毛细血管管腔扩张，PAS阳性物质增多不明显。 以上实验结果表明，“糖肾康”对大鼠的降糖作用不明显，但可降低蛋白尿、阻止肾小球的增大及减少PAS阳性物质的沉积。证实“糖肾康”合剂对糖尿病模型大鼠肾脏有保护作用，可延缓糖尿病肾病的出现。 糖尿病肾病的发病机理较为复杂，包括血流动力学异常、肾脏肥大、代谢紊乱、兔疫功能紊乱和遗传因素。中医中药防治糖尿病肾病有显著疗效的报道有很多，但机理研究却较少。文献报导，“糖肾康”合剂中的黄蔑可阳氏血浆渗透压，抑制肾脏诱生型一一氧化氮合成酶 2 实肚性大鼠糟尿病肾病及“＠肾康”的预防作用（iNOS）的表达，从而部分纠正肾肌的血流动力学异常，对实验大鼠肾脏有保护作用。也有报导，黄蔑、丹参、白术、麦冬在不同的治疗糖尿病的复方中都对糖尿病肾病患者的肾脏有保护作用。在总结了前人的经验后，导师应用益气养阴、补益脾肾、活血阻络的中药，配成复方“糖’肾康”。在动物实验中己发现对糖尿病大鼠肾脏有保护作川，可延缓l。AS阳性物质的增多及减少蛋白尿。其作川机制有待进一步研究。
Diabetic Nephropathy (DN) is the pathological changes of glomerulus, calyx and renel vessel result from diabetes. DN as one of the serious clinical coalitions directly affects the prognosis of diabetes. The high perfusion of glomerulus and the hypertrophy of nephron can be observed at early stage of DN, the pathological changes of glomerulus, renal vessel and calyx along with the process of the disease. Experiment on animal shows that the kidney gets hypertrophy and GBM of glomerulus become thick, later the GFR of glomerulus decreases, and albumin in urine gradually increases, all of those changes leads to the prostration of kidney. Morden medicine mainly focus on dropping blood sugar and blood pressure to treat DN, the combination treatment of traditional chinese medicine and modem medicine not only focus on lowering the blood pressure and blood sugar but also improving the function of kidney. The relation between histology changes and clinical process of rat DN and preventive treatment with TCM compound ang shen kang?are studied in this paper. SD model of rat diabete was made by rentrally injecting STZ. Animals was divided into four groups, that is, group of theraping with ang shen kang?, no treatment SD group, group of treating with nalapril maleate tablets?and control group. When urine protein positively appears in 90 percent of diabetesrats, the experiment was terminated. bIood sugar, together with urine sugar, andurine albumin of the experiment ammals were measured, the kidneymorphological changes was also observed and analyzed. The result suggests thatcomparing the group treating with "tang shen kang" with that of the westernmedicine group and control group, albuinuria in group of "tang shen kang" aresignificently lower than that in the other two groups. In "tang shen kang"treating groLIp, low content of protein in calyx was also observed under thelnicrosecopc. The enlangn1ent of glumertllus was observed in all groups, whilethe result is not significent in the grotIp of""rSK". Testing PAS positive mattershow that the resuIt of "TSK" treating group is evidently lower than that of theother three groups. The increase of PAS positive matter content and thedilatation of caPillary vessel were simutaneously observed both in SD group and"Enalapril maleate tablets" group, the dilatation of capillary vessel was mairilypresented in "TSK" treating group, increasing of PAS POsitive matter contentwas not evident.All the result suggest that the effect of "bog shen kang" on dropping bloodsugar is not distinctive, but it"s effects on decreasing albuminuria, preventing theeniargement of glomerulus and tLhe accunulation of PAS POsitive matter areevident. It indicates that "tang shen kang" have the ft1nction of protecting thekidney in DN ratS and deIaying the occuring of DN.The pathogenesis of DN is compIicate, it includs the abnormaI of bloodstream kinetics, kidney hroertrophy, decomPensation, ifnmtalty dysfunction5and inherit factors. There are a lot of reports about the prevention and treating DN with Traditional Chinese Medicine, but the study of the mechanism is very few. It is reported that Astragalus root of 搕ang shen kang?drops the plasm osmotic pressure and inhibite the expressing of kidney induced INOS, hence it has the function of protecting kidney by partly correct the abnormal blood kinetics. It is also reported that in different TCM compound, red sage root of red salvia and mongolian milkvetch atractylodes ovata and ophiopogon have a protecting effect on the kidney of DN patients. On the base of experience done by predecessor, my tutor formulate the prescription of 搕ang shen kang? Experiments on rats shows that 揟SK?has the protecting effect on rat抯 kidney, it postpones the increase of PAS positive matter and reduces the albuminuria content. The detail mechanism of the effects still need further study.
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