参附注射液对兔体外循环时胰岛素抵抗的影响

Effect of Shenfu injectio on insulin resistance in rabbits undergoing cardiopulmonary bypass

目的探讨参附注射液SFI对兔CPB时胰岛素抵抗的影响。方法健康成年新西兰大白兔30只，雌雄不拘，体重2．2～2．5kg，随机分为3组（n=10），假手术组（S组）和CPB组腹腔注射等容量生理盐水，SFI组于CPB前2d、1d及麻醉诱导前30rain时腹腔注射SFI 10ml／kg。于麻醉诱导后5min（T1）、主动脉阻断即刻（T2）、主动脉开放5min（T3）、主动脉开放35min（T4）和主动脉开放75min（T5）时采集动脉血样，测定血糖及胰岛素水平，并计算胰岛素抵抗指数（HOMA-IR）。于CPB150min时取右后肢股四头肌组织，测定骨骼肌胰岛素受体底物-1（IRS-1）、磷脂酰肌醇3激酶p85亚单位（P13Kp85）、葡萄糖转运蛋白（GLUT）4的表达水平。结果与，T1时比较，3组T2-5时血糖、胰岛素水平及HOMA-IR均升高（P〈0．05）；与s组比较，CPB组和SFI组T2-5时血糖、胰岛素水平及HOMA．IR均升高，P13Kp85及GLUT4表达下调（P〈0．05）；与CPB组比较，SFI组T2-5时血糖水平及HOMA—IR降低，胰岛素水平升高，P13Kp85及GLUT4表达上调（P〈0．05）。结论SFI可改善CPB诱导的兔胰岛素抵抗，其机制可能与上调骨骼肌胰岛素信号转导分子的表达有关。

Objective To investigate the effect of Sbenfu injectio on insulin resistance in rabbits undergoing cardiopulmonary bypass （CPB）. Methods Thirty New Zealand white rabbits of both sexes weighing 2.2-2.5 kg were randomly divided into 3 groups （ n = 10 each） ： group I sham operation （group S） ; group II CPB and group III CPB ＋ Shenfu injectio （group SFI）. In group III （group SFI） Shenfu injectio 10 ml/kg was injected intraperitoneally （IP） once a day for 2 days and at 30 min before anesthesia. In group II and III the duration between aortic cross-clamping and unclamping was 60 min. MAP was maintained at 50-60 mm Hg during CPB. The plasma glucose and insulin concentrations were measured immediately after induction of anesthesia （TI ）, immediately after aortic cross-clamping （T2）, and at 5, 35 and 75 min after aortic unclamping （T3 , T4, T5） and insulin resistance index （HOMA-IR） was calculated. The expression of insulin receptor substrate-1 （IRS-1）, phosphatidyl-inositol 3 kinase （PI3Kp85） and glucose transporters （GLUT4） in skeletal muscle was detected at 150 min of CPB by immuno-histochemistry. Results Compared with the baseline values at TI, plasma glucose and insulin concentrations and HOMA-IR were significantly increased at T2.5 in all 3 groups （P 〈 0.05）. CPB significantly increased the plasma glucose and insulin concentrations and HOMA-IR at T2-5 in group II and as compared with group S （P 〈 0.05）. The expression of PI3Kp85 and GLUT4 in muscle was significantly decreased in group II and III as compared with group S （ P 〈 0.05）. Shenfu injectio significantly decreased plasma glucose concentration and HOMA-IR and increased plasma insulin concentration in group m as compared with group II . Shenfu injectio significantly attenuated the CPB-induced changes in IRS-1, P/3Kp85 and GLUT4 expression in muscle. Conclusion Shenfu injectio can ameliorate CPB-induced insulin resistance and the mechanism may be related to the up-regulation of the expression of insulin signal transduction molecules in skeletal muscle.