• 糖尿病急症并发横纹肌溶解综合征的实验相关性研究
  • The Experimental Study of Correlative Factors in Rhabdomyolysis with Diabetic Emergencies
  • 桂书彦,张木勋.糖尿病急症并发横纹肌溶解综合征的实验相关性研究[J].内科急危重症杂志,2015,21(21):
    DOI:
    中文关键词:  横纹肌溶解综合征  糖尿病高糖高渗状态  肌酸磷酸激酶
    英文关键词:Rhabdomyolysis(RM)  Hyperglycemic hyperosmolar status(HHS)  Creatine phosphokinase(CK)
    基金项目:
    作者单位E-mail
    桂书彦 桂书彦 guishuyan0760@126.com 
    张木勋 华中科技大学同济医学院附属同济医院 zhangmuxun0760@126.com 
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    中文摘要:
          目的 研究不同的代谢紊乱状态与骨骼肌细胞损伤的关系,探讨糖尿病急症并发横纹肌溶解综合征(RM)的可能机制。方法 建立糖尿病急症大鼠模型,进行实验分组:Ⅰ组,糖尿病组(DM),给予腹腔注射STZ(链脲佐菌素),60mg/Kg; Ⅱ组,急性高钠模型组,给予腹腔注射4M NaCl,0.8ml/100g; Ⅲ组,糖尿病高渗组(HHS),成功制造糖尿病模型2周后,给予氢化可的松,局部肌肉注射4-6天,并于注射第三天开始禁水,不禁食,禁水持续1-3天,直到大鼠出现神经症状;Ⅳ组,正常对照组(Normal),腹腔注射等量生理盐水;Ⅴ组,激素对照组,正常wistar大鼠,与糖尿病高渗组模型同期,单纯给予局部肌肉注射氢化可的松5天。收集实验大鼠血清标本,检测血清肌酸激酶(CK)、血糖、血钠等生化指标;并同期取大鼠骨骼肌、心肌组织标本,行HE染色,光镜下(40×)观察形态学改变。结果 1)与其他组相比,DM组血糖(24.6±3.2mg/L)及HHS组(52.8±0.7mg/L)血糖明显升高(P<0.05),HHS组血渗透压(397.8±13mOsmol/L)及高钠组血渗透压(378.3±40mOsmol/L)明显增高(P<0.05),且血清CK值(2023±1292IU/L,2382±1069IU/L)也明显高于其他组(P<0.05)。2) RM大鼠中,血钠、血渗透压与CK呈正相关(r=0.32, p=0.03; r=0.42, p=0.01)。3) 組织学观察:HE染色,光镜下观察糖尿病高渗组与急性高钠组可见明显骨骼肌细胞溶解征象,对照组无明显异常。结论 高血钠和高血渗透压是糖尿病状态下RM的发生的主要危险因素。
    英文摘要:
          Abstract Objective: Tstracto establish the animal models with metabolic disorder caused by hyperglycemia 、hypernatremia and hyperosmosis, and to examine the etiology and evaluate the determinants of rhabdomyolysis in the diabetic emergencies. Methods: 40 Male Wister rats were randomly divided into five groups, Group Ⅰ: diabetic mellitus (DM), induced by intraperitoneal(i.p) injection of 60mg/Kg streptozotocin(STZ). GroupⅡ: acute hypernatremia group, Hypernatremia was induced by intraperitoneal (i.p) injection of 0.8ml/100g 4M NaCl. Group Ⅲ: HHS/EHD(Experimental Hyperosmolar Diabetic) :diabetic rats were treated with cortisol for 4-6days by intramuscular (IM) injection, water was withheld from the third day of steroid treatment , and continued for 1-3 days until the development of the neurological symptoms. Group Ⅳ: normal control, intraperitoneal(i.p) injection of isotonic saline, instead of diabetogenic agent. groupⅤ: cortisol control group, treated normal rats with cortisol (hydrocortisone acetate 5mg, daily by intramuscular injection for 5 days; water was permitted ad libitum. Subsequently, bood samples were collected to detect serum creatine kinase, serum sodium, and mean serum osmolality and so on. Skeletal muscle tissues were harvested, embedded in paraffin and sectioned at 4um. Slides were stained by H&E and the general structure of the muscle tissue was studied by light microscope. Results: 1) Compared to the other groups, the serum glucose elevated (P<0.05) in GroupⅠ(24.6±3.2mg/L)and Group Ⅲ (52.8±0.7mg/L),but not in other groups; The mean serum osmolality was much higher (P<0.05) in Group Ⅲ(397.8±13mOsmol/L); The serum sodium level elevated in Group Ⅱ(172.7±8.3mmol/L) than other groups(P<0.05), and the mean serum osmolality(378.3±40mOsmol/L) was much higher; The mean serum creatine phosphokinase was much higher (P<0.05) in Group Ⅱ(2382±1069IU/L) and Group Ⅲ(2023±1292IU/L) than other three groups. 2) There was a linear association between serum CK versus serum sodium and serum CK versus serum osmolality(r=0.32, p=0.03; r=0.42, p=0.01). 3) Histological observation: H