摘要
非酒精性脂肪肝病(nonalcoholic fatty liver disease,NAFLD)是一种肝组织病理学改变的临床综合病变。与酒精性肝病相类似,但无过量饮酒史。因为其具有患病率高、隐匿性、肝纤维化、肝硬化等发展特点.所与对NAFLD的防治工作已经受到国内外的广泛关注。关于脂肪肝的发病机制,众多研究者一致认为与脂联素(Adi)、瘦素(Lep)、Lep受体有一定联系。Lep是由脂肪细胞分泌的一种蛋白质。在正常的生理情况下, Lep分泌的多少,均可反馈到下丘脑中枢系统,调节副交感神经,以适应饥饿或者摄食的反应[1]脂联素是一种以脂肪组织为唯一来源的活性多肽,它在机体肥胖时表达下调大量研究提示[2-3],脂联素和Lep在NAFLD的发生发展中起到了重要的作用.
下丘脑区域是机体内分泌和能量代谢活动的重要结构区。尤其下丘脑-神经肽通路系统在摄食反馈环路中起到了关键作用。Lep及其受体是传入饱食信号的信使因子作用于下丘脑黑色素-4受体及其配体黑色素细胞刺激素,而Lep发挥信使作用的关键则依靠下丘脑的中枢调节效应。大量实验证实,电针可以调整患者体内的内分泌系统,这是针刺效应的作用机制之一.电针治疗NAFLDA已经得到大量实验的证实,关于其作用机制也有通过干预肝细胞色素表达和氧化抗氧化作用进行治疗的说法[4]。
中医纯天然疗法——针灸疗法,已被纳入世界医学的组成部分。对针灸作用机理的研究也倍受关注。故本研究通过检测电针治疗后的大鼠检测Lep、脂联素等相关指标,探讨电针对NAFLD的治疗机制。
目的
检测机体脂联素水平及下丘脑Lep、瘦素受体基因(mRNA)表达,探讨电针治疗非酒精性脂肪肝的作用机制。
方法
将远交群大鼠(Sprague Dawley,SD)32只随机为模型组22只及空白组10只。普通饲料喂养空白组,高脂饲料喂养模型组制备SD大鼠模型。8周后再将模型组大鼠随机分为:对照组(11只)、针刺组(11只)。治疗针刺组,取“丰隆”、“足三里”、“阴陵泉”、“三阴交”等穴进行针刺并加以频率10 Hz,强度1. 5 V的连续波;治疗4周后,检测各组大鼠血清甘油三酯(Trglyceride,TG)、血清胆固醇(serum cholesterol,TC)、Lep、脂联素,观察肝组织病理学变化,并用逆转录转胺霉链聚合反应( Reverse Transcription-Polymerase Chain Reaction,RT-PCR)方法检测下丘脑组织中Lep和瘦素受体mRNA的表达。
结果
1一般情况:
各组大鼠在实验期间正常饮水摄食,饮水量,摄食量无明显异常。对照组大鼠皮毛有光泽、体态活泼;模型组大鼠体重明显增加、形体肥胖、皮毛发黄、蓬乱不顺滑。解剖观察空白组大鼠肝脏肉眼观察呈鲜红色,边缘锐利,表面光滑。模型组大鼠肝脏体积增大,边缘变钝,颜色呈土黄色,切面呈油腻状。
2 HE染色:模型组大鼠:肝细胞胞浆内有大量脂肪空泡呈透明状,细胞核被脂
肪空泡挤到肝细胞缘,病理证实脂肪肝形成造模成功。电针组经过治疗后,肝脂肪组织变性程度有所减轻,肝细胞结构趋于正常。
3 Lep、脂联素指标:
与模型组比较电针组肝组织匀浆中Lep水平显著上升、脂联素水平显著降低、血清中TC、TG值显著下降。
4 RT-PCR实验结果:
RT-PCR检测显示:模型组大鼠Lep和瘦素受体的mRNA表达明显下降,电针组大鼠下丘脑Lep及瘦素受体mRNA表达上调。见图4、
5,图像分析系统分析显示:电针对NAFLD大鼠下丘脑Lep、瘦素受体mRNA表达水平升高。
结论:
经过8周的高脂饲料喂养的NAFLD大鼠造模成功。电针可以影响实验大鼠下丘脑Lep、瘦素受体mRNA表达水平,缓解脂肪代谢紊乱情况,达到对NAFLD的治疗作用,推测电针治疗NAFLD病的作用机制可能是通过“针刺效应”作用于神经-内分泌调控系统,调整Lep、瘦素受体mRNA表达和脂联素水平。
Non-alcoholic fatty liver disease is a type of liver tissue pathology clinical syndrome. And alcoholic liver disease similar to, but no history of excessive drinking. Because of their prevalence is high, the occult, hepatic fibrosis and cirrhosis and other developmental characteristics. and on the prevention and treatment of NAFLD have been affected by the widespread interest both at home and abroad. About the pathogenesis of fatty liver, numerous researchers unanimously and adiponectin (Adi) and leptin (Lep), leptin receptors have a certain contact. .Lep is produced by fat cells and a protein. In a normal physiological situations, Lep quantities, can be fed back to the central system, regulating hypothalamus parasympathetic nervous system, to accommodate the hunger or feeding of reaction[1] adiponectin is a unique source of adipose tissue to polypeptides, its body obesity Downregulation of research tips, adiponectin and leptin in the development of NAFLD played an important role [2] [3].
The body of the hypothalamic area is the body of the endocrine and metabolic activity of important structural areas. In particular, the hypothalamus-neuropeptides pathway in the feeding of the feedback loop into play. Leptin and leptin receptors is the Messenger of the incoming signal to the full in the hypothalamus melanin-4 receptors and their ligands melanin-melanocyte-stimulating hormone leptin, and play a key role in the courier and rely on the hypothalamus regulation effect. A large number of laboratory confirmed, electro-acupuncture can be adjusted with the endocrine system, this is the mechanism of the effect of acupuncture. Electroacupuncture NAFLDA has been a large number of experiments confirmed, about its mechanism of action through hepatic cytochrome expression and antioxidant effects for oxidation treatment of [4].
Acupuncture as a natural therapy, has been incorporated into the world of medicine. At the same time, the mechanism of acupuncture is also widely appreciated. Therefore this study by detecting electroacupuncture of rats detection leptin, adiponectin, and other related indicators, on treatment of electroacupuncture NAFLD.
Objective:
Inspection body adiponectin levels and hypothalamus leptin (Lepton, Lep), its receptor gene expression (mRNA), on the treatment of non-alcoholic fatty liver disease (nonalcoholic fatty liver disease, NAFLD) of the mechanism of action.
Method
The distant Sprague Dawley rats (Group, SD) 32 random to model group 22 only and empty group 10 only. The normal feed blank group, high fat diet fed model preparation SD rat model group. 8 week will randomly divided into rat model group: a control group (11 only), acupuncture Group (11 only). Treatment of acupuncture group, the "comments", "in", "vaginal mausoleum Springs", "Taichong", "over", and other points to acupuncture and frequency 10 Hz, strength of 1. 5 v CW; treatment of 4 weeks, each group of serum triglyceride (TG), Trglyceride, serum cholesterol (serum cholesterol, TC), serum Lep, adiponectin, observation histopathological changes in the liver, and RT-transfer amine by chain polymerization (Reverse Transcription-Polymerase Chain Reaction, RT-PCR) method for detecting hypothalamus Lep and its receptor mRNA expression.
Results
1 outward appearance:
Each group of rats in the experiment does drinking water during feeding, drinking water, food consumption without obvious exception. The control group of rats fur glossy, posture and lively; model group rats obviously increase, body fat, skin discoloration, apparently not. An empty set of rat liver Visual inspection is bright red, edge sharpness, smooth surface. Model group see rat liver enlargement with the naked eye, edge blunt, washed Khaki, slice is greasy. Join the mouse after making photos
2 HE dyeing show:
Model group rats: hepatocytes cytoplasmic high levels of fat vacuoles are clear, the nucleus is fat vacuoles crush into liver cell margin, pathology confirmed fatty liver has formed. Electroacupuncture group treatment, liver fatty tissue denaturation far, liver cell structure also tend to be normal.
3 Leptin、adiponectin index
The treatment group and model group compared liver tissue homogenate leptin levels markedly. Liver tissue homogenate adiponectin levels have significantly lower serum TG TC, a marked decline.
4 RT-PCR
RT-PCR Detection shows: model group rats Lep and its receptor mRNA are noticeably, electro-acupuncture group hypothalamic Lep and leptin receptors increases. Lep optical density Analyzer on NAFLD hypothalamic, its receptor mRNA expression comparison table 2).
Conclusion
After eight weeks of fat rat feeding NAFLD have been making success. Experimental electro-acupuncture can influence hypothalamic Lep, its receptor mRNA expression, mitigation fat metabolism disorders, reached therapeutic effect on NAFLD, speculated that the treatment of non-alcoholic fatty liver disease mechanisms through "effect" effect to neuro-endocrine regulation system, adjustment of the Lep, its receptor mRNA expression and adiponectin levels.
引文
[1].张莉,柳涛,王淼,邢练军,季光,郑培永.降脂颗粒对非酒精性脂肪肝大鼠下丘脑Lep`及瘦素受体的影响中西医结合肝病杂志2009 19(2):88-91.
[2]. Fruhbeck G, Jebb SA, Prentice AM.Leption:Physiology and Path physiology [J] .Clan Physiol,1998,18 (5) :397~399.
[3].张素真,魏红,魏洁血清瘦素与肥胖、脂肪肝患者相关性探讨潍坊医学院学报-2007年4期
[4].曾志华,卓廉士.电针治疗非酒精性脂肪肝大鼠肝细胞色素P450+2E1的影响.针刺研究.2009年
[5]. Fruhbeck G, Jebb SA, Prentice AM.Leption:Physiology and Path physiology [J] .Clan Physiol,1998,18 (5) :397~399.
[6].罗华丽,李荣亨.电针对单纯性肥胖瘦素及脂联素的影响[J].针刺研究2007.(32) (4)
[7]. Wang S J, Xu H Z, Xiao H L. Effect of High-frequency Electro acupuncture on Lipid Metabolism in Obesity Rats[J]. Zhen Ci Yan Jiu (Acupunct Res, Chin) 2008,33(3):154-158。
[8]. Luo H L, Li R H. Effect of Electro acupuncture on Leptin and Adiponectin in Simple Obesity Patients[J].Zhen Ci Yan Jiu(Acupunct Res, Chin) 2007 32(4)(264-267).
[9].康锁彬,高秀领,王少锦.针刺治疗单纯性肥胖及其对患者血清瘦素的影响.中国针灸,2005 ,25 (4) :243– 245 5
[10].李文娟,陈伟.瘦素及其诱导的信号传导途径.解放军医学杂
[11].张莉,柳涛,王淼,邢练军,季光,郑培永.降脂颗粒对非酒精性脂肪肝大鼠下丘脑瘦素`及瘦素受体的影响中西医结合肝病杂志2009 19(2):88-91.
[12]. Zhang Y,Proenca M,Maffei M,et a1.Positional cloning of the obese gene and its human homologue.Nature,1994,372:425~432.
[13]. Yu WH.Walczewska A.Kimura M,et a1.Nitric oxide mediates leptin—induced luteinizing hormonereleasing hormone(LHRH)and LHRHand leptin—induced LHrelease from the pituitary gland.Endocrinology,1997,138(11):5055~5058.
[14]. Qiao Y,Ma X,Cui H.Influence of leptin on luteinizing hormone and follicle stimulating hmmone secreted from cultured rat anterior pituitary ceils.Neural Regen Res,2008,3(6):656~658.
[15]. Akhter N,Johnson BW ,Crane C,et a1.Anterior pituitary leptin expression changes in different reproductive states : In Vitro stimulation by gonadotropin—releasing hormone.J Histochem Cytochem,2007,55(2):15l~166.
[16]. Qiao Y,Cui H.Intraeerbroventricular leptin injection affects neuroefl—docrine reproductive axis in ovariectomized rats.Neural Regen Res,2008,3(8):907~909.
[17]. Mantzoms CS.Role of leptin in reproduction.AnnNY Aead Sci,2000.900 174~183.
[18]. Chart JL,Matarese G,Shetty G,Ket a1.Diferential regulation of metab 0lic. Neuroendocrine and immune function by leptin in humans.PNAS,2006,103(22):8481—8486.
[19]. Ma X,Zubcevic L,Briining JC,et a1.Electrical inhibition of identi·fled anorexigenic POMC neurons by orexin hypocretin[J] Neurosci,2007,27(7):1529~1533.
[20]. Goldstone AP,Unmehopa UA,Bloom SR,et a1.Hypothalam ie NPYand agouti—related protein are increased in human illness but not inPrader—Willi syndrome and other obese subjects.J Clin EndoerinolMetab,2002,87(2):927~937.
[21]. Finn PD,Cunningham MJ,Pau KY,et a1.The stimulatory efect of leptin on the euroendocrine reproductive axis of the monkey.Endo·crinology,1998,139(11):4652~4662.
[22]. Friedman JM,Halaas JL.Leptin and the regu lation of body weight in mammals.Nature,1998,395(67o4):763~770.
[23]. Morrison CD,Morton GJ,Niswender KD,et a1.1eptin inhibits hypo—thalamic NPY and AgRP gene expression via a echanism that requiresphosphatidylin0sitol 3一OH—kinase signaling.Am J Physiol EndocrinolMetab,20o5,289(6):1051~1057.
[24]. Bouret S,Chuoi-Mariot MT,Prevot V,et a1.Evidence that TGF betamaydirectly modulate POMC mRNA expression in the female rat arcuatenucleus.Endocrinology,2001,142(9):4055—4065.
[25]. Mercer JG,Moat KM,Ross AW ,et 81.Photoperiod regulates arcuateucleus POMC,AGRP,an d leptin receptor mRNA in Siberian hamsterhypothalam us.Am J Physiol Regulatory Integrative Comp Physiol,2oo().278(1):271~281.
[26]. Sehirth HB.The physiological role of melanocortin receptors.Vita rains and Horm ones,2001,63:195~232.
[27]. Shimizu.H.Inane K.Mori M.The leptin—dependent and independ entmelanocortin signaling system:regulation of feeding and energyexpenditure.J Endocrinol,2007,193(1):1—9.
[28].杨松鹤,赵连志,王小强,孙铁成,程露阳,乔跃兵瘦素经POMC神经元对神经内分泌--生殖轴的影响.中国计划生育学杂志.2010年第3期总第174期
[29].张素真,魏红,魏洁血清瘦素与肥胖、脂肪肝患者相关性探讨潍坊医学院学报-2007年4期
[30].张莉,柳涛,王淼,邢练军,季光,郑培永.降脂颗粒对非酒精性脂肪肝大鼠下丘脑瘦素`及瘦素受体的影响中西医结合肝病杂志2009 19(2):88-91.
[31]. Luo H L, Li R H. Effect of Electroacupuncture on Leptin and Adiponectin in Simple Obesity Patients[J].Zhen Ci Yan Jiu(Acupunct Res, Chin) 2007 32(4)(264-267).
[32]. Aimin XU Adiponectin and AdipoR1 regulate PGC-1alpha and mitochondria by Ca(+) and AMPK/SIRT1. Iwabu M, et al. Nature. 2010 Mar 31. [Epub ahead of print]
[33]. Kern P A, Di Gregorio G B, Lu T, et al.Adiponectin expression from human adipose tissue: relation to obesity, insulin resistance, and tumor necrosis factor2alpha exp ression [J]. D iabet, 2003, 52(7): 1779 - 85.
[34]. Zhang L, Liu T, Wang M, Xing L J, Ji G, Zheng P Y. Effect of Jiangzhi granula on leptin and leptin receptor of hypothalamus in rats with nonalcoholic liver disease[J].Zhong Xi Yi Jie He Gan Bing Za Zhi(CHINESE JOURNAL OF INTEGRATED TRADITIONAL AND WESTERN MEDICINE ON LIVERDISEASES) 2009 19(2):88-91.
[35]. Zhang L, Liu T, Wang M, Xing L J, Ji G, Zheng P Y. Effect of Jiangzhi granula on leptin and leptin receptor of hypothalamus in rats with nonalcoholic liver disease[J].Zhong Xi Yi Jie He Gan Bing Za Zhi(CHINESE JOURNAL OF INTEGRATED TRADITIONAL AND WESTERN MEDICINE ON LIVER DISEASES) 2009 19(2):88-91.
[36].天津中医药大学《实验针灸学》天津科学技术出版社。
[37].徐放明针刺对Ⅱ型糖尿病大鼠弓状核神经细胞自发放电的影响针刺研究2003 28(1)
[38].李沛,徐放明不同时间针刺对雌性恒河猴生殖内分泌影响的实验研究中国针灸2002(3)。
[39].王会芝刘庆计针刺通乳疗效观察[j]现代中西医结合杂志2002 3。
[40].涂乾,王华,王亚文,吴绪平·电针内关穴后下丘脑室旁核、β-内啡肽及白细胞介素的变化2006年11期
[41].冯文琪,曾志华,卓廉士.电针对非酒精性脂肪肝大鼠胰岛素抵抗的影响[J].针刺研究2008 33(2):111-115.
[42].赵玫,袁锦虹,李嘉,等.针刺对实验性肥胖大鼠下丘脑摄食中枢的影响.中国针灸,2001~21(5):305
[43]. Rizk NM Stammsen D,Preibisch G ,el 6/ .Leptin and umor necrosis factor alpha induce the tyrosin phosphorylation of signal transducer and activator of transcription proteins in the hypothalamus of normal rats in vivo.End0crinO1Ogy.2001;142(7):3027—3032.
[1].曾民德.脂肪肝.中华消化杂志.1999;19(2):120—122.
[2]. Angulo P,Lindor KD.Treatment of nonalcoholic fatty liver:present andemerging therapies.Semin Liver Dis,2001,21(1):81—88.
[3].曾志华,卓廉士.电针治疗非酒精性脂肪肝大鼠肝细胞色素P450+2E1的影响.针刺研究.2009年
[4].徐慧芬针刺治疗非酒精性脂肪肝32例浙江中医药大学学报
[5].田虹电针艾灸治疗单纯肥胖性脂肪肝30例临床观察[会议论文]田虹,金丽敏,2004 - 2004西南片区针灸学术研讨会
[6]. Qing F,Pan jQ,Xiao LY,et a1.Effect of puerarin on insulin sensitivity andblood glucose and lipids levels in insulin—resisting hypertension rats.Zhong YiYah Jiu.2006;19(3):14—17.
[7]. Zhang Y,P roenca P yM afeiM,et a1.Positional cloning of the mouse obese geneand its hulnan homologue[J].Na—ture,1994,372(6505):425—432.
[8]. Cohen P.M iyazaki M,Socci ND,et d.Role for stearoyl—CoA desaturase一1 in leptin mediated weightloss.Science.2002;297(5579):240—243.
[9]. Saxena NK.Ikeda K,Rockey DC,el a1.Leptin in hepatic fibrosis:evidencefor increased collagenproduction in satellite cells and lean[ittermates of ob/obmice.Hepatology.2002;35(4):762—771.
[10]. Rizk NM。Stammsen D,Preibisch G,el 6/.Leptin and umor necrosis factoralpha induce the tyrosin phosphorylation of signal transducer and activator oftranscription proteins in the hypothalamus of normal rats invivo.End0crinO1Ogy.2001;142(7):3027—3032.
[11].贺石林,李俊成,秦晓群.临床生理学.北京:科学出版社.2001
[12]. Tobe K,Suzuki R,Aoyama M,el af.Increased expression of the sterolregulatory element—binding protein—l gene in insulin receptor substrate mouse)Tobe K,Ogura J,Tsuka M,a1.Relationship between serum leptin and fattyliver in Japnese male adolescent university students.Am J Gastroentero1.1999;94(11):3328—3335.
[13]. Chitturi S。Farrell G,Frost L,el a1.Serum leptin in NASH correlates with hepatic steatosis but not fibrosis : a manifestation of lipotoxi- city. Hepatology. 2002;36(2):403—409.
[14]. Campillo B,Sherman E,Richardet JP,et a1.Serumleptin levels in alcoholic liver cirrhosis: relationshipwith gender, nutritional status, liver function andenergy metabolism. Eur J Clin Nutr. 2001;55(1):98O --988.
[15]. Bartek T, Rudolf C, Ker?en U, Klein B Studies on substrate utilisation in L: -valine-producing Corynebacterium glutamicum strains deficient in pyruvate dehydrogenase complex.
[16].肖维刘义龚成尹婕王冬花盛慧JAK2/STAT3信号传导通路在瘦素促进子宫内膜癌细胞增殖中的作用华中科技大学同济医学院附属协和医院妇产科,武汉43002
[17]. , Koteish A。Diem AM . Animal models of statuses.Semin Liver Dis. 2001;21(1):89—104. Koteish A.Diem AM
[18]. Carpenter LR, Farruggella TJ, Symes A, et a1.Enhancing leptin response by preventing SH 2一containing phosphates 2 interaction with ob receptor. Proc NatlAcad Sci U S A.1998;95(11):6061-6066
[19]. Crouse JA。Elliott GE,Burgess TI , a1.Altered cellsurface expression and signaling of leptin receptorscontaining the fatty mutation. J Biol Chem. 1 998;273(29):18365—18373.)
[20].郑培永,葛根关于对非酒精性脂肪肝大树肝脏受体mrna和磷酸化janus激酶2/磷酸化信号转录激活因子3的影响,中西医结合学报,2008年。)
[21]. Zhao CY。Li L。Li JM ,et a1.Change in the expressionof leptin receptor in liver of rats with non—alcoholic fattyliver disease.Zhongguo Zu Zhi H ua Xue Yu Xi Bao HuaXue Za Zhi. 2005; 14(6): 613-617. Chinese withabstract in English)
[22]. Day C P,James O F.Steatohepatitis:a tale oftwo“hits”[J].Gastroenterology,1998,114(4):842—845.
[23]. Bastard J P,Maachi M,Lagathu C,et a1.Recent advancesin the relationship betw een obesity,infl ammation,and insulin resistance[J].European eytokine
[24]. Rashid I,Robeas E A.Nonalcoholic steatohepatitis in children[J]_Pediatr Gastroenterol Nutr,2002,30(6):48)
[25]. Anderwald C,Muller G,Koca G,et a1.Shoa—term LP—dependent inhibition of hepatic~ueoneogenesis is mediated by insulin receptor ubstrate一12[J].Molinol,2002,16:12
[26].杨文英,邢小燕,潘孝仁,等.高甘油三酯血症是非胰岛索依赖型糖尿病发病的危险因素——432例非糖尿病人群六年前瞻性观察.中华内科杂志,1995,34:583-586.)
[27].非酒精性脂肪肝是胰岛素抵抗的早期标志)
[28].范建高.代谢综合征与脂肪肝[J].国外医学:内分泌学分册,2002,22(5):273-275.)
[29].中学教师NAFLD与胰岛素抵抗及代谢疾病的关系胡艳文,胡曼云,牟希金,唐海滨,陈顺香,李丽莉(贵阳市第四人民医院,贵州贵阳550002))
[30].冯文琪,曾志华,卓廉士.电针对非酒精性脂肪肝大鼠胰岛素抵抗的影响[J].针刺研究2008 33(2):111-115.