壳聚糖合并中药对大鼠脂肪肝治疗作用及其机制的研究
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摘要
脂肪肝主要是由于肝脏摄入、合成脂肪与其分泌、氧化分解之
间失衡 引起中性脂肪（主要为甘油三酯）在肝内积聚所致。目前，
国内外尚无理想的针对脂肪肝的特效治疗药物。甲壳素（chitin），是
从动物甲壳中提取的一类线性高分子多糖，其脱乙酰化产物—壳聚糖
具有多种药理作用，动物实验表明壳聚糖能有效地降低血胆固醇。此
外，许多中药如何首乌、丹参、牛膝、泽泻等亦均有良好的降脂作用。
我们在以前的研究中，用壳聚糖合并中药何首乌、丹参、牛膝预防
大鼠脂肪肝取得了一定的效果，但其治疗作用如何尚未探讨，
且预防组大鼠肝脂质含量与正常组相比有一定的差异。据文献报道中
药决明子和泽泻有明显的降脂作用，故我们设想在原药的基础上添加
决明子和泽泻，可能在治疗实验中会起到更好的治疗脂肪肝的作用。
本实验通过建立大鼠脂肪肝模型，研究了原药（治疗药物1）及在其
基础上添加决明子和泽泻后的药物（治疗药物2）对脂肪肝的治疗作
用及其机理，以筛选更有效的治疗脂肪肝的药物，为临床治疗脂肪肝
提供理论依据。
本实验在小剂量四氯化碳致肝损伤基础上合并高脂饮食建立大
鼠脂肪肝模型，分别给予治疗药物1和治疗药物2进行治疗实验，结
果发现四氯化碳合并高脂饮食可引起大鼠肝脏明显的脂肪变性，表现
为肝组织TG、TC含量显著增加，并伴有血清ALT活性增高。病理
切片检查显示：肝细胞肿胀，内部充满大小不等的脂滴，而药物治疗
组大鼠肝脏TG、TC值均明显降低，以治疗组2下降最明显。光镜
下药物治疗组肝细胞脂变程度明显减轻，表现为脂滴减少，脂变面积
缩小，尤以治疗组2脂变程度最轻，已基本接近于正常水平。另外，
治疗药物2还可使大鼠血清ALT活性明显降低，说明其具有一定的
南京医科大学硕十学位论文
保肝作用。结跪明治疗药物1和2哪8栅均有明显治疗作用，而
治疗药物二的治疗滁锄明显。
过剥匕物酶体增殖物激活受体（PPARs）是一类s敝…物
酶体增鞭H8顺，贝特类酬旨药）腑的核内弧，翩内激
素受体超账。自1990年由Issmann拄J见以来，国夕呐绷十分
WM的研究铡，其亚型PPARaM内龈代谢动妒铡
拗中走星霎卧作用。目前普遍认为，脂凡m汗患酮源。防内毒素血巧良
发病锨高，内跪（ET）可引起肿瘤坏死因子。（TN’F。）a
谢。，而鞭的腑表明TNFa可引娜内PPARamRNA衅及
蛋白衅的下降，濒TNF a可能通旬减少PPAR anlltNHM引
栅内脂质…L，从而邮girl：’w＂’＝ 中卿用。止时，游离脂
赔（FFA）在脂腑的发病邮仲 占重要地位，而脂瞅时FFA
增加与PPAR。系杉邓H贿关。因此，本研究还应用半定量逆转录一
聚合哟韩色良应（m－Pm）法观察了壳聚糖合并中药对大脐——
a mRNAmRNA铀的影响，并测定了大鼠血清ET、TTNF、FTA发J刊庄FFA
的变化，以过卜一步从J卜于水刁o开究其发挥治疗作用的邮0。结贩明，
脂 组大肌PPARa铀明显减少；娠ET、M、FFA
含量和肝FFA衅均明显增力民经药物治疗后肝PPARa 焕
肚常郴，娠ET、TN’F、FFA含量和肝FFA材均明显均下民
综上所述，壳聚糖合并中药可明显咧氏实验哪8栅大鼠扦脏
脂质飨，减洲8变程度 刷B蝴明显治疗作用。其治疗衅
可能除了减少肠铡旨肪的测妙，助能与贩PPARa协减
轻ET、TNF、FFA毒断用有关。
Fatty liver, or hepatic steatosis, may occur in a variety of situations in
which lipid uptake or synthesis overwhelms the capacity of the liver to
oxidate and secrete them, leading to their accumulation. Triglyceride is the
main lipid found in most cases of fatty livers. Chitin, a kind of linear
macromolecular aminopolysaccharide prepared from the exoskeletons of
crabs and shrimps, has many pharmacological effects. Previous studies
have indicated that chitosan, the partly deacetylated derivative of chitin, can
prevent the experimental hypercholesterolemia of rat. In addition,
traditional Chinese medicines such as Polygonum multifiorum
Thumb.,Salvia miltiorrhiza Bge., and Achyranthes bidentata BL. have
satisfactoiy effect on treating fatty liver. Our previous study identified that
cbitosan and traditional Chinese medicines including Polygonum
multiflorum Thumb.,Salvia miltionhiza Bge. and Achyranthes bidentata
BL.(drug 1) had a remarkable effect on preventing fatty liver, but its effect
on treating fatty liver had not been studied yet . It was reported that Cassia
obtasifolia L. and Alisma plantago L. had favorable effect on reducing liver
lipid accumulation. So Cassia obtasifolia L. and Alisma plantago L. were
added to the above-mentioned drug (drug 2) to strengthen its function of
inhibiting the lipid deposition in liver. In this study, we investigated the
effect and mechanism of drug 1 and drug 2 on rat fatty liver in order to
search for a drug treating fatty liver effectively.
Male Rats were treated with a low dose of carbon tetrachloride (CC14)
and fed a high fat diet to produce fatty liver. Then, the therapeutic groups
were treated with drug 1 and drug 2. The concentrations of triglyceride
(TG), total cholesterol (TC) and alanine aminotransferase (ALT) were
detected and the mohology changes of hepatocyte were evaluated to
assess the therapeutic effect The results demonstrated that the combining
use of CCLI and high-fat diet induced the contents of TG, TC in liver to
increase significantly. Pathological examinations showed that swelling
hepatocytes were filled with lipid droplets in model group while the treated
group displayed a slight seeatosis and a lower TG, TC contents compared
with the model group. Among the treated group the effect of drug 2 was
more effective. Moreover, drug 2 also made the ALT activity decrease.
Peroxisome proliferator-activated receptors (PPARs) are members of
the nuclear steroid hormone receptor superfamily activated by structurally
diverse chemicals referred to as peroxisome proliferators such as fatty acids
and fibrate lipid-lowering drugs. Studies over the past few years have
shown that the a -isoform of the receptors , PPAR a, is a key regulator of
lipid homeostasis. It is established that tumor necrosis factor (TNF) and
free fatty acids (FFAs) play a pivotal role in the pathogenesis of fatty liver.
Studies recently identified that the mRNA for PPAR a was significantly
reduced by TNF a treatment. In addition, the level of PPAR a protein
was also decreased after TNF a treatment. This effect may have important
implications in perturbation of the lipid metabolism induced by TNTF a.
Studies also found that deletion of PPAR a gene leads to a remarkable
decrease in FFAs uptake. Consequently, we hypothesize that PPAR a
involves in the pathogenesis of fatty liver. To explore the molecular
mechanism of chitosan and traditional Chinese medicines in treating fatty
liver, hepatocyte PPAR a expression was analyzed and the concentrations
间失衡 引起中性脂肪（主要为甘油三酯）在肝内积聚所致。目前，
国内外尚无理想的针对脂肪肝的特效治疗药物。甲壳素（chitin），是
从动物甲壳中提取的一类线性高分子多糖，其脱乙酰化产物—壳聚糖
具有多种药理作用，动物实验表明壳聚糖能有效地降低血胆固醇。此
外，许多中药如何首乌、丹参、牛膝、泽泻等亦均有良好的降脂作用。
我们在以前的研究中，用壳聚糖合并中药何首乌、丹参、牛膝预防
大鼠脂肪肝取得了一定的效果，但其治疗作用如何尚未探讨，
且预防组大鼠肝脂质含量与正常组相比有一定的差异。据文献报道中
药决明子和泽泻有明显的降脂作用，故我们设想在原药的基础上添加
决明子和泽泻，可能在治疗实验中会起到更好的治疗脂肪肝的作用。
本实验通过建立大鼠脂肪肝模型，研究了原药（治疗药物1）及在其
基础上添加决明子和泽泻后的药物（治疗药物2）对脂肪肝的治疗作
用及其机理，以筛选更有效的治疗脂肪肝的药物，为临床治疗脂肪肝
提供理论依据。
本实验在小剂量四氯化碳致肝损伤基础上合并高脂饮食建立大
鼠脂肪肝模型，分别给予治疗药物1和治疗药物2进行治疗实验，结
果发现四氯化碳合并高脂饮食可引起大鼠肝脏明显的脂肪变性，表现
为肝组织TG、TC含量显著增加，并伴有血清ALT活性增高。病理
切片检查显示：肝细胞肿胀，内部充满大小不等的脂滴，而药物治疗
组大鼠肝脏TG、TC值均明显降低，以治疗组2下降最明显。光镜
下药物治疗组肝细胞脂变程度明显减轻，表现为脂滴减少，脂变面积
缩小，尤以治疗组2脂变程度最轻，已基本接近于正常水平。另外，
治疗药物2还可使大鼠血清ALT活性明显降低，说明其具有一定的
南京医科大学硕十学位论文
保肝作用。结跪明治疗药物1和2哪8栅均有明显治疗作用，而
治疗药物二的治疗滁锄明显。
过剥匕物酶体增殖物激活受体（PPARs）是一类s敝…物
酶体增鞭H8顺，贝特类酬旨药）腑的核内弧，翩内激
素受体超账。自1990年由Issmann拄J见以来，国夕呐绷十分
WM的研究铡，其亚型PPARaM内龈代谢动妒铡
拗中走星霎卧作用。目前普遍认为，脂凡m汗患酮源。防内毒素血巧良
发病锨高，内跪（ET）可引起肿瘤坏死因子。（TN’F。）a
谢。，而鞭的腑表明TNFa可引娜内PPARamRNA衅及
蛋白衅的下降，濒TNF a可能通旬减少PPAR anlltNHM引
栅内脂质…L，从而邮girl：’w＂’＝ 中卿用。止时，游离脂
赔（FFA）在脂腑的发病邮仲 占重要地位，而脂瞅时FFA
增加与PPAR。系杉邓H贿关。因此，本研究还应用半定量逆转录一
聚合哟韩色良应（m－Pm）法观察了壳聚糖合并中药对大脐——
a mRNAmRNA铀的影响，并测定了大鼠血清ET、TTNF、FTA发J刊庄FFA
的变化，以过卜一步从J卜于水刁o开究其发挥治疗作用的邮0。结贩明，
脂 组大肌PPARa铀明显减少；娠ET、M、FFA
含量和肝FFA衅均明显增力民经药物治疗后肝PPARa 焕
肚常郴，娠ET、TN’F、FFA含量和肝FFA材均明显均下民
综上所述，壳聚糖合并中药可明显咧氏实验哪8栅大鼠扦脏
脂质飨，减洲8变程度 刷B蝴明显治疗作用。其治疗衅
可能除了减少肠铡旨肪的测妙，助能与贩PPARa协减
轻ET、TNF、FFA毒断用有关。
Fatty liver, or hepatic steatosis, may occur in a variety of situations in
which lipid uptake or synthesis overwhelms the capacity of the liver to
oxidate and secrete them, leading to their accumulation. Triglyceride is the
main lipid found in most cases of fatty livers. Chitin, a kind of linear
macromolecular aminopolysaccharide prepared from the exoskeletons of
crabs and shrimps, has many pharmacological effects. Previous studies
have indicated that chitosan, the partly deacetylated derivative of chitin, can
prevent the experimental hypercholesterolemia of rat. In addition,
traditional Chinese medicines such as Polygonum multifiorum
Thumb.,Salvia miltiorrhiza Bge., and Achyranthes bidentata BL. have
satisfactoiy effect on treating fatty liver. Our previous study identified that
cbitosan and traditional Chinese medicines including Polygonum
multiflorum Thumb.,Salvia miltionhiza Bge. and Achyranthes bidentata
BL.(drug 1) had a remarkable effect on preventing fatty liver, but its effect
on treating fatty liver had not been studied yet . It was reported that Cassia
obtasifolia L. and Alisma plantago L. had favorable effect on reducing liver
lipid accumulation. So Cassia obtasifolia L. and Alisma plantago L. were
added to the above-mentioned drug (drug 2) to strengthen its function of
inhibiting the lipid deposition in liver. In this study, we investigated the
effect and mechanism of drug 1 and drug 2 on rat fatty liver in order to
search for a drug treating fatty liver effectively.
Male Rats were treated with a low dose of carbon tetrachloride (CC14)
and fed a high fat diet to produce fatty liver. Then, the therapeutic groups
were treated with drug 1 and drug 2. The concentrations of triglyceride
(TG), total cholesterol (TC) and alanine aminotransferase (ALT) were
detected and the mohology changes of hepatocyte were evaluated to
assess the therapeutic effect The results demonstrated that the combining
use of CCLI and high-fat diet induced the contents of TG, TC in liver to
increase significantly. Pathological examinations showed that swelling
hepatocytes were filled with lipid droplets in model group while the treated
group displayed a slight seeatosis and a lower TG, TC contents compared
with the model group. Among the treated group the effect of drug 2 was
more effective. Moreover, drug 2 also made the ALT activity decrease.
Peroxisome proliferator-activated receptors (PPARs) are members of
the nuclear steroid hormone receptor superfamily activated by structurally
diverse chemicals referred to as peroxisome proliferators such as fatty acids
and fibrate lipid-lowering drugs. Studies over the past few years have
shown that the a -isoform of the receptors , PPAR a, is a key regulator of
lipid homeostasis. It is established that tumor necrosis factor (TNF) and
free fatty acids (FFAs) play a pivotal role in the pathogenesis of fatty liver.
Studies recently identified that the mRNA for PPAR a was significantly
reduced by TNF a treatment. In addition, the level of PPAR a protein
was also decreased after TNF a treatment. This effect may have important
implications in perturbation of the lipid metabolism induced by TNTF a.
Studies also found that deletion of PPAR a gene leads to a remarkable
decrease in FFAs uptake. Consequently, we hypothesize that PPAR a
involves in the pathogenesis of fatty liver. To explore the molecular
mechanism of chitosan and traditional Chinese medicines in treating fatty
liver, hepatocyte PPAR a expression was analyzed and the concentrations
引文
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49. Schoonjans K et al. Induction of the Acyl-coenzyme A synthetase gene by fibrates and fatty acids is mediated by a peroxisome proliferator response element in the C promoter. J Biol Chem, 1995; 270(33): 19269-19276
50. Dreyer C et al. Control of the peroxisomal β-oxidation Pathway by a novel family of nuclear hormone receptors. Cell, 1992; 68(5): 879-887
51. Keller H et al. Fatty acids and retinoids control lipid metabolism through activation of peroxisome proliferator-activated receptor-retinoid x receptor heterodimers. Proc Nath Acad Sci USA, 1993; 90(6): 2160-2164
52. Gulick T et al. The perorisome proliferator-activated receptor regulates mitochondrial fatty acid oxidative enzyme gene expression. Proc Nath Acad Sci USA, 1994; 91(23): 11012-11016
53. Muehoff AS et al. The peroxisome proliferator-activated receptor
mediates the induction of CYP4A6,a cytochrome P450 fatty acid ω-hydroxylase by clofibric acid. J Biol chem, 1992; 267(27) : 19051-19053
54． Rodriguez JC et al. Peroxisome proliferator-activated receptor mediates induction of the mitochondrial 3-hydroxy-3-methylglutaryl-COA synthase gene by fatty acids. J Biol Chem, 1994; 269(29) : 18767-18772
55． Vu-Dac N et al. Negative regulation of the human apolipoprotein A-Ⅰ promoter by fibrates can by attenuated by the interaction of the peroxisome proliferator-activated receptor with its response element. J Biol Chem, 1994; 269(49) : 31012-31018
56． Vu-Dac N et al. Fibrates increase human apolipoprotein A-Ⅱ expression through activation of the peroxisome proliferator-activated receptor. J Clin Invest, 1995; 96:741
57． Hertz R et al. Mode of action of peroxisome proliferators as hypolipidemic drugs. J Biol Chem, 1995; 270(22) : 13470-13475
58． Hashimoto T et al. Peroxisomal and rnitochondrial fatty acid β-oxidation in mice nullizygous for both peroxisome proliferator-activated receptor a and Peroxisomal fatty acyl-CoA oxidase. J Biol Chem, 1999; 274(27) : 19228-19236
59． Aoyama T et al. Altered constitutive expression of fatty acid-metabolizing enzymes in mice lacking the peroxisome proliferator-activeted receptor α (PPAR α). J Bio Chem. 1998; 273(10) : 5678-5684
60． Leone TC et al. A critical role for the peroxisome proliferator activated receptor α (PPAR α) in the cellular fasting response:the PPAR α-null mouse as a model of fatty acid oxidation disorders. Proc Nath Acad. Sci USA, 1999; 96(13) : 7473-7478
61． Wigg AJ et al .The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia and tumour necrosis factor alpha in the pathogenesis of non-alcoholic steatohepatitis. Gut, 48(2) : 206-211
62． Mehran M et al. Tumor necrosis factor-alpha inhibits lipid and lipoprotein transport by Coco-2 cells. Am J Physiol, 1995; 269(6Pt1) : 262-265
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66． Martin G et al. Coordinate regulation of the expression of the fatty acid transport protein and acyl-CoA synthetase genes by PPAR α and PPAR γ activators. J Biol Chem, 1997; 272:28210-28217
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47. Juge-Aubry CE et al. Peroxisome proliferator-activated receptor mediates cross-talk with thyroid receptor by competition for retinoid x receptor. J Biol Chem, 1995; 270:18117
48. Cottlicher M et al. Fatty acids activate a chimera of the clofibric acidactivated receptor and the glucocorticoid receptor. Proc Natl Acad Sci USA, 1992; 89:4653
49. Schoonjans K et al. Induction of the Acyl-coenzyme A synthetase gene by fibrates and fatty acids is mediated by a peroxisome proliferator response element in the C promoter. J Biol Chem, 1995; 270(33): 19269-19276
50. Dreyer C et al. Control of the peroxisomal β-oxidation Pathway by a novel family of nuclear hormone receptors. Cell, 1992; 68(5): 879-887
51. Keller H et al. Fatty acids and retinoids control lipid metabolism through activation of peroxisome proliferator-activated receptor-retinoid x receptor heterodimers. Proc Nath Acad Sci USA, 1993; 90(6): 2160-2164
52. Gulick T et al. The perorisome proliferator-activated receptor regulates mitochondrial fatty acid oxidative enzyme gene expression. Proc Nath Acad Sci USA, 1994; 91(23): 11012-11016
53. Muehoff AS et al. The peroxisome proliferator-activated receptor
mediates the induction of CYP4A6,a cytochrome P450 fatty acid ω-hydroxylase by clofibric acid. J Biol chem, 1992; 267(27) : 19051-19053
54． Rodriguez JC et al. Peroxisome proliferator-activated receptor mediates induction of the mitochondrial 3-hydroxy-3-methylglutaryl-COA synthase gene by fatty acids. J Biol Chem, 1994; 269(29) : 18767-18772
55． Vu-Dac N et al. Negative regulation of the human apolipoprotein A-Ⅰ promoter by fibrates can by attenuated by the interaction of the peroxisome proliferator-activated receptor with its response element. J Biol Chem, 1994; 269(49) : 31012-31018
56． Vu-Dac N et al. Fibrates increase human apolipoprotein A-Ⅱ expression through activation of the peroxisome proliferator-activated receptor. J Clin Invest, 1995; 96:741
57． Hertz R et al. Mode of action of peroxisome proliferators as hypolipidemic drugs. J Biol Chem, 1995; 270(22) : 13470-13475
58． Hashimoto T et al. Peroxisomal and rnitochondrial fatty acid β-oxidation in mice nullizygous for both peroxisome proliferator-activated receptor a and Peroxisomal fatty acyl-CoA oxidase. J Biol Chem, 1999; 274(27) : 19228-19236
59． Aoyama T et al. Altered constitutive expression of fatty acid-metabolizing enzymes in mice lacking the peroxisome proliferator-activeted receptor α (PPAR α). J Bio Chem. 1998; 273(10) : 5678-5684
60． Leone TC et al. A critical role for the peroxisome proliferator activated receptor α (PPAR α) in the cellular fasting response:the PPAR α-null mouse as a model of fatty acid oxidation disorders. Proc Nath Acad. Sci USA, 1999; 96(13) : 7473-7478
61． Wigg AJ et al .The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia and tumour necrosis factor alpha in the pathogenesis of non-alcoholic steatohepatitis. Gut, 48(2) : 206-211
62． Mehran M et al. Tumor necrosis factor-alpha inhibits lipid and lipoprotein transport by Coco-2 cells. Am J Physiol, 1995; 269(6Pt1) : 262-265
63． 曾民德．脂肪肝-肝病领域的新挑战．中华肝脏病杂志，2000， 8(2) ：69
64． Diehl AM et al. Nonalcoholic steatohepatitis. Semin Liver Dis, 1999; 19:221-229
65． Motojima K. et al. Expression of putative fatty acid transporter genes are regulated by peroxisome proliferator-activated receptor alpha and gamma activators in a tissue-and inducer-specific manner. J Biol Chem, 1998; 273:16710-16714
66． Martin G et al. Coordinate regulation of the expression of the fatty acid transport protein and acyl-CoA synthetase genes by PPAR α and PPAR γ activators. J Biol Chem, 1997; 272:28210-28217