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：40只大鼠随机分成5组,每组8只.糖尿病组（DM）给予腹腔注射STZ（链脲佐菌素）60 mg/Kg;急性高钠模型组给予腹腔注射4M NaC1 0.8 mL/100 g;糖尿病高渗组（HHS）给予氢化可的松局部肌肉注射4～6d,并于注射第3天开始禁水,不禁食,禁水持续1～3 d,直到大鼠出现神经症状;正常对照组腹腔注射等量生理盐水;激素对照组单纯给予局部肌肉注射氢化可的松5 mg,5d.检测5组大鼠血清肌酸激酶（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＆#215;）观察形态学改变.结果：与其他组相比,DM组及HHS组血糖明显升高（P＜0.05）,HHS组及高钠组血渗透压明显增高（P＜0.05）,且血清CK值也明显高于其他组（P＜0.05）;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）.HE染色,光镜下可见糖尿病高渗组与急性高钠组有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发生的主要危险因素.
Objective： To study the relationship between the different status of metabolic disorder and skeletal muscle cell damage, and to explore the possible mechanism of rhabdomyolysis in diabetic emergencies. Methods ： Forty male Wister rats were randomly divided into five groups （8 for each group） ： diabetic mellitus （DM） group were given 60mg/kg strepto- zotocin （STZ） by intraperitoneal injection. Acute hypematremia group were induced by intraperitoneal injection of NaCl 0. 8mL/100 g 4 M. Hyperglycemic hyperosmolar status （HHS） group were treated with cortisol for 4 - 6 days by intramuscu- lar injection, water was withheld from the third day of steroid treatment, and continued for 1 ~ 3 days until the development of the neurological symptoms. Normal control group received intraperitoneal injection of isotonic saline. Cortisol control group were given hydroeortisone acetate 5mg, daily by intramuscular injection for 5 days. Serum creatine kinase （CK）, serum so- dium, and mean serum osmolality and so on were detected in 5 groups. Skeletal muscle tissue and myocardial tissue were harvested, embedded in paraffin and sectioned at 4 p.m. Slides were stained by HE and the morphologie changes were ob- served under microscope. Results： Compared with those of the other groups, the blood glucose elevated significantly in DM group and HHS group （ P 〈 0.05 ）. The mean serum osmolality was significantly elevated in HH$ group and hypematremia group （ P 〈 0.05 ）, and the mean serum CK was much higher in these two groups compared with those of the other groups （ P 〈 0.05 ）. Serum sodium and osmolality were positively correlated with the serum CK （ r = 0.32, P = 0.03 ; r = 0.42, P = 0.01 ）. HE staining showed morphologic changes of skeletal muscle under the microscope in acute hypernatremia group and HHS group which were characterized by karyopyknosis, no obvious abnormality was seen in the control group. Conclusion： High levels of the serum sodium and osmolality are the major determin
出处
《内科急危重症杂志》
2015年第2期132-135,共4页
Journal of Critical Care In Internal Medicine
