【作者】 李娜；

【导师】 杨钦河；

【作者基本信息】 暨南大学 ， 中西医结合基础， 2008， 硕士

【摘要】 目的:观察并比较疏肝、健脾、综合治法及方药对大鼠非酒精性脂肪性肝病的治疗作用,探讨疏肝健脾治法及方药治疗非酒精性脂肪性肝病的作用机理,为临床运用疏肝法与健脾法治疗脂肪肝提供实验依据。方法:利用高脂饲料复制大鼠非酒精性脂肪性肝病实验动物模型,SD雄性大鼠76只,其中10只作为正常对照组（正常组）,66只经12周造模后,随机处死6只检测造模情况。造模成功后,60只实验大鼠分疏肝组、健脾组、疏肝加健脾组（综合组）、模型对照组（模型组）、三七脂肝丸治疗组（三七组）和自然恢复组（自复组）,并给予相应药物治疗或对应处理。治疗8周后处死大鼠,腹主动脉穿刺采血,测定各组大鼠血清中TC、TG、HDL-C、LDL-C、AST、ALT含量;取新鲜肝组织匀浆测各组大鼠肝组织中TC、TG含量;取肝组织标本作病理切片,常舰HE染色,观察病理形态学变化,并取新鲜肝组织液氮冻存,采用RT-PCR方法检测肝组织UCP₂mRNA变化;采用免疫组化的方法检测肝组织中UCP₂蛋白活性的变化。结果:1.血脂:与正常组比较,模型组大鼠血清TC、TG、LDL-C水平均显著增高（P＜0.01）,血清HDL-C含量显著下降（P＜0.01）。与模型组比较,各实验组大鼠血清TC、TG、LDL-C含量下降,疏肝组、综合组下降最为显著（P＜0.01）;血清HDL-C含量升高,疏肝组、健脾组、综合组和自复组升高有显著性差异（P＜0.01）。2.肝功:与正常组比较,模型组大鼠血清ALT、AST含量升高,具有显著性差异（P＜0.01）:与模型组比较,疏肝、健脾、综合、自复组大鼠血清ALT、AST含量下降,有显著性差异（P＜0.01）;三七组有下降趋势,无统计学差异。3.肝脂:与正常组比较,模型组大鼠肝组织中TC、TG含量升高,具有显著性差异（P＜0.01）;与模型组比较,健脾组大鼠肝TC含量下降,有显著性差异（P＜0.05）;各用药组大鼠肝TG含量下降,均有统计学差异（P＜0.05）。4.病理:光镜观察模型组大鼠肝组织呈中度肝细胞脂肪变性,肝细胞增大,胞浆内脂滴大小不一,细胞水肿,汇管区炎细胞浸润,有部分纤维增生。疏肝组、健脾组和综合组大鼠肝组织未见明显脂肪变,部分肝细胞呈小空泡状,以疏肝组最为明显。自复组和三七组大鼠肝组织呈轻度脂肪变。5.肝组织UCP₂mRNA的表达:与正常组比较,模型组大鼠肝组织中UCP₂mRNA高表达,具有显著性差异（P＜0.05）;与模型组比较,各用药组UCP₂mRNA表达水平均有下降,疏肝组、健脾组和综合组具有显著性差异（P＜0.05）。6.肝组织UCP₂蛋白表达:正常组UCP₂蛋白表达检测不出,模型组高表达。与模型组比较,疏肝、健脾、综合、自复、三七组均有显著性差异（P＜0.01）,综合组和健脾组组间无统计学差异（P=0.14）,其余各组组间差异有统计学意义（P＜0.05）。结论:1.控制高脂饮食,调整饮食结构对早期NAFLD的逆转有重要意义。2.疏肝和健脾方药对NAFLD大鼠的血脂、肝功及肝脂均有调节作用,能促进大鼠脂质代谢,保护肝细胞,显示出良好的治疗非酒精性脂肪性肝病的作用,疏肝方药显示出更好的治疗趋势。3.肝脾失调是NAFLD早期的重要病机,疏肝、健脾是其重要治法,都能通过改善脂质代谢达到治疗脂肪肝的目的。疏肝法在非酒精性脂肪性肝病病变早期的治疗中可能具有更明显和更重要的作用。4.疏肝健脾方药可以使大鼠肝组织中UCP₂基因和蛋白表达下调,提示UCP₂可能是中药治疗NAFLD发挥作用的靶点之一。更多还原

【Abstract】 Objective:To observe the therapeutic effects of soothing liver,invigorating spleen,integrated methods and their typical recipes on NAFLD rats,to explore the possible mechanism,and to provide experimental foundation for the clinical use of the soothing liver and invigorating spleen therapies treating NAFLD.Methods:76 male SD rats were randomly divided into two groups:high fat diet group（n=66,fed with high fat diet） and the normal group（n=10,fed with normal diet）.At the end of 12th week,6 rats were randomly selected for hepatic histopathology examination.When the rat model of NAFLD was confirmed,the remaining 60 NAFLD rats were subdivided into 6 equal subgroups:soothing liver group,invigorating spleen group,integrated group,Sanqizhiganwan group,model control group and natural recovery group.Rats in the anterior 4 groups were fed with corresponding medications by perfusion while the remaining rats were fed with equal volume of distilled water. Meantime,rats in the model group were continuously fed with high fat diet while rats in other groups were fed with normal diet.At the end of 20th week,all rats were sacrificed.TG,TC,AST, ALT contents in the serum and TC,TG contents in the hepatic homogenate were detected by automatic biochemical analyzer.Plasma insulin concentration was measured by radioimmunoassay.The expression of UCP₂mRNA and UCP₂ proteins in liver tissue were respectively examined by reverse transcription polymerase chain reaction（RT-PCR） and immunohistochemistry respectively.Results:（1） Compared to normal group,contents of serum TC,TG,LDL-C in model control group were significantly increased（P＜0.01）,while content of serum HDL-C was obviously decreased （P＜0.01）.Compared to model control group,contents of serum TC,TG,LDL-C in treatment groups were significantly decreased（P＜0.01）,especially in the soothing liver and integrated group（P＜0.01）;Serum HDL-C was increased,especially in the soothing liver group, invigorating spleen group,integrated group and natural recovery group（P＜0.01）.（2）Contents of serum AST,ALT in model control group were significantly increased（P＜0.01, compared to normal group）,while they were decreased in the treatment groups,especially in the soothing liver,invigorating spleen,integrated and natural recovery group（P＜0.01,compared to model control group）.However,no statistical significance was found between the treatment groups.（3） Contents of TC,TG in the hepatic homogenate in model control group were significantly increased（P＜0.01,compared to normal group）,while TC content was decreased in invigorating spleen group.Compared to model group,TG content in the treatment groups were decreased （P＜0.05）.（4） Light microscope observation revealed medium fatty degeneration in hepatocytes in model group:swelling of hepatocytes and different sizes of lipid droplets inside the cytoplasm. Inflammatory cells were seen in the portal area.No obvious fatty degeneration was seen in hepatic tissue of soothing liver,invigorating spleen and integrated group,especially in the soothing liver group.Liver tissue of natural recovery group and Sanqizhiganwan group showed mild fatty degeneration.（5） Result of RT-PCR showed that UCP₂ mRNA expression was little in hepatic tissue of normal group,high expression in model control group（P＜0.05,compared to normal group）. Compared to model control group,UCP₂ expression in liver tissue of other groups was decreased, especially for the soothing liver,invigorating spleen and integrated group（P＜0.05） and the least expression is in the soothing group.（6） Immunohistochemistry showed no expression of UCP₂ protein in liver tissue of normal group,high expression in model control group.Compared to model control group,UCP₂ protein expression in hepatic tissue of other groups was dramatically decreased（P＜0.01）.No statistical significance was found between invigorating spleen group and integrated group（P=0.14）,while it was found between other two groups（P＜0.05）.Conclusion:（1）Removal of the cause（high fat diet control） is significant in reversing NAFLD in the early stage.（2）Soothing liver,invigorating spleen methods and recipes showed good prevention function in NAFLD:improving lipid metabolism and reducing serum AST and ALT.（3） Disturbance of the spleen and liver function were the main pathogenesis of NAFLD in the early stage,and therapies of soothing liver and invigorating spleen are the main therapeutic methods.Soothing liver therapy has a relative better effect in the treatment of NAFLD in the early stage.（4） There was a high expression of UCP₂ mRNA and protein in liver tissue of model rats with NAFLD and decreased expression in the treatment groups,which suggest a close correlation between UCP₂ protein and occurrence and development of NAFLD.Soothing liver and invigorating spleen recipes can down-regulate the expression of UCP₂,which maybe the therapy target for Chinese herbs treating NAFLD.更多还原