长期氧疗对慢性阻塞性肺疾病患者骨骼肌代谢影响的研究

目的:探索长期氧疗对慢性阻塞性肺疾病患者呼吸功能、血气以及骨骼肌代谢的影响。方法:将68例住院的COPD患者随机分为观察组和对照组。两组都接受常规治疗,观察组另外给予24个月的氧疗。测量记录两组治疗前后COPD患者肺功能、血气分析、血流动力学以及骨骼肌代谢指标。结果:长期氧疗组COPD患者的肺功能和血气指标MVV、TV、FVC,FEV1明显增加,PaO2和SaO2较氧疗前有明显的提高,而PaCO2较氧疗前明显下降;血流动力学指标sPAP、mPAP、dPAP、PVR分别降低了41.18%、45.71%、47.43%、21.88%,CI和SVI较氧疗前分别提高了19.04%和35%;骨骼肌肌力、骨骼肌横断面积、Ⅰ型肌纤维比例、氧化酶活力较氧疗前分别提高了50%、17.47%、7.87%、28.08%,而Ⅱ(a、b、c)型肌纤维比例、糖酵解、骨骼肌蛋白分解代谢速率较氧疗前分别减低了20.50%、42.85%、34.66%、37.70%。两组各指标差异均达到显著或极显著水平,具有统计学意义。结论 :LTOT能改善COPD患者肺功能、减轻低氧症状;降低肺血管阻力和肺动脉压降低,稳定肺动脉压,避免了肺动脉压的不断继续恶化;改善肌力,增加骨骼肌横断面积;提高I型肌肉纤维比例以及氧化酶活力下降,最终改善COPD患者临床症状,扩大病患活动范围和生活质量。

Effect of berberine on glucolipid metabolization in diabetic skeletal muscle and its mechanism

Aim To investigate the effect of berberine on damaged morphology and glucolipid metabolization in skeletal muscle of diabetic rat and the relationship between peroxisome proliferator-activated receptor （PPARs） α/γ/δ protein expression. Methods Type 2 diabetes mellitus rats were induced by an injection of 35 mg.kg^-1 streptozotocin （STZ） and a high-carbohydrate/ high-fat diet for 16 weeks. From week 17 to 32, diabetic rats were given low-, middle-, high-dose berberine （75, 150, 300 mg.kg^-1）, fenofibrate （100 mg.kg^-1） and rosiglitazone （4 mg.kg^-1） by oral administration, respectively. The skeletal muscle structure was observed with hematoxylin-eosin （HE） staining, glycogen and triglyceride contents were measured by spectrophotometry and PPAR α/γ/δ protein expressions were detected by immunohistochemistry. Results Fiber distribution remained normal in skeletal muscles of all the groups, middle-, high-dose berberine partly improved diabetic fibre atrophy, increased glycogen and decreased triglyceride levels in diabetic muscle （P〈 0.01）. Middle-, high-dose berberine and rosiglitazone all significantly reduced PPARy protein level in diabetic skeletal muscle （P 〈 0.01）; middle-, high-dose berberine and fenofibrate strikingly increased both PPARu and PPAR8 expression （P〈 0.01）. Conclusion Berberine modulates PPAR α/γ/δ protein expression in diabetic skeletal muscle which may contribute to ameliorate fibre damage and glucolipid metabolization.