摘要
目的探讨抗生素联合皮质激素防治肾盂肾炎延迟治疗时肾皮质瘢痕的效用及机制。方法大鼠分为正常组(A),模型组(B)、左旋氧氟沙星及时治疗组(C)、左旋氧氟沙星加激素延迟治疗组(D)、左旋氧氟沙星延迟治疗组(E),分别于30d、60d、90d测量各组肾小管功能(尿NAG/Cr)、肾功能(Scr、BUN)、24h尿蛋白定量,第90天统计各组肾皮质瘢痕率,RT-PCR及免疫组化测量肾组织TGF-β1mRNA及蛋白水平表达。结果B组第90天出现尿NAG/Cr显著升高,与A、C、D组比较有显著性差异(P﹤0.01);实验期间各组肾功能、24h尿蛋白均无显著差异。C、D组二级及以上瘢痕发生率显著减少(P﹤0.05),D组总体瘢痕率显著减少。RT-PCR及免疫组化提示各组较A组TGF-β1表达增加;相对于B组,C、D组TGF-β1肾内表达显著抑制,E组无此作用。结论延迟治疗时抗生素联合皮质激素有助于减少肾皮质瘢痕发生,单独使用抗生素无此作用。
Objective To explore the effects of antibiotics combined with corticosteroid on suppressing renal scarring in treatment-delayed chronic pyelonephrits （CPN）. Methods An experimental CPN model in rats was developed. All animals were divided into five groups including group A （normal group）, group B （model group）, group C （Lev- ofloxacin Lactate/LFL treatment given 24h after operation）, group D （delayed treatment with LFL and methylprednisone giv- en 72h after operation） and group E （delayed treatment with LFL given 72h after operation）. Urine N-acety1-beta –D- glocosamidase （NAG） was detected, and other laboratory parameters including serum creatinine （Scr）, blood urea nitrogen （BUN）, 24 hour urinary protein secretion at 30d, 60d and 90d respectively. After the rats were sacrified, renal scarring and pathological changes were observed. Transforming growth factor-beta 1 （TGF-β1） of kidney was examined with RT-PCR and immunohistochemistry in the end. Results CPN rat model was successfully built based on pathological changes. Urinary NAG/Cr significantly increased at 90d in group B （P ﹤0.01 versus group A）, but that of group C and D did not have such increase （P ﹤0.01 versus group B）, while treatment E failed （P ﹥0.05 versus group B）. Results of Scr, BUN and 24 hour urinary protein secretion in all groups didn’t show any difference during the whole study period. Severe scarring of Group C （P ﹤0.05） and D （P ﹤0.01） decreased significantly （grade 2 and 3） compared with group B. The total renal scar- ring rate also decreased in group D（P ﹤0.05）. Group E didn’t show the same protective effects. Compared with group A, a significant TGF -β1 increase was observed in group B in kidney mRNA and protein level （P ﹤ 0.01 versus group A）, meanwhile, that of group C and D reversed such increase （P﹤0.01 versus group B）, but group E failed. Conclusions If antibiotic treatment is delayed, antibiotics combined with methylprednisone are helpful to avoid renal scarring.
出处
《北京医学》
CAS
2010年第7期555-558,共4页
Beijing Medical Journal
基金
上海中医药大学自然基金(05XJ004)
上海市教委高校创新团队项目支持
关键词
慢性肾盂肾炎
肾瘢痕
左旋氧氟沙星甲
基泼尼松龙
延迟治疗
Chronic pyelonephritis
Renal scarring
Levofloxacin Lactate
Methylprednisone
Delayed treatment
