早期糖尿病膀胱尿动力学及cajal样细胞的变化和意义

Changes and Significances of Urodynamics and Cajal-like Cells in Diabetic Cystopathy of the Early Stage

目的:观察早期糖尿病在膀胱尿动力学和cajal样细胞上的病理学改变,探讨其发生机制及病理演绎过程。方法:建立早期糖尿病豚鼠模型40只(病变组),以正常豚鼠20只作对照(对照组),饲养10周后行膀胱最大收缩压、漏尿点压等尿动力学指标测定。然后将两组豚鼠膀胱制作成冷冻切片行免疫荧光染色及激光共聚焦显微镜观察。结果:10周后,与对照组比较,病变组膀胱最大容量(P<0.05)、漏尿点压(P<0.01)、顺应性(P<0.05)、剩余尿量(P<0.01)增加,而膀胱静息压(P<0.01)、最大逼尿肌压(P<0.05)下降,激光共聚焦显微镜下见糖尿病组膀胱逼尿肌中cajal样细胞数量减少(P<0.01),cajal样细胞二聚体消失(P<0.01)。结论:糖尿病膀胱病变豚鼠早期有尿动力学异常,cajal样细胞数量减少并伴有该细胞二聚体结构消失,提示早期糖尿病膀胱病变是高糖环境下发生了具有起博功能的cajal样间质细胞异常,从而使逼尿肌功能障碍及尿动力学发生改变;而真正起逼尿功能的平滑肌细胞失去该细胞起博而处于一种待激发的"休眠状态"。因此,临床上应针对这种情况进行干预,以控制病情的进一步恶化。

Objective：To observe the histopathological changes of urodynamics and cajal-like cells in the early stage of diabetic cystopathy （DCP）. To study the onset mechanism and pathology procedure. Methods： 40 guinea pig models and 20 controls were developed. After 10 weeks in both groups the maximum bladder pressure, the leak point pressure e were measured. Finally Making frozen section of the bladder of two groups were observed by Laser scanning confocal microscope. Results： After 10 weeks, in the diabetic rats, the maximum bladder capacity （P〈0.05）, the leak Point Pressure （P〈0.01）, compliance （P〈0.05） and residual urine （P〈0.01）were increased, however the resting bladder pressure （P〈0.01）, the maximum bladder pressure （P〈0.05） decreased compared to that in the control group. The cajal like cells of the diabetic group showed significantly decreased in quantity （P〈0.01） and a disappearance of the structure of co cajal -like cells （P〈0.01）. Conclusions： There was the abnormality of urodynamics in early DCP. The cajal like cells decreased in quantity and with disappearance of the structure of co cajal like cells. It suggests high blood sugar environments have damaged cajal like cells with the pacemaker-like function in early DCP, which results the abnormality of detrusor contraction and dynamic parameter, however it is dormant status to force the urine from the real function of detrusor cells, the cajal-like cells Should be targeted for its intervention to control the further deterioration of conditions.