目的 探討加味生脈散對(duì)膿毒癥大鼠急性腎損傷的影響。方法 將60只SPF級(jí)健康成年雄性SD大鼠隨機(jī)分為對(duì)照組、假手術(shù)組、模型組和加味生脈散低、中、高劑量（10、20、30 g/kg）組，每組10只。除對(duì)照組外，采用盲腸結(jié)扎穿孔術(shù)建立膿毒癥大鼠模型，假手術(shù)組不進(jìn)行盲腸結(jié)扎和穿孔，其余操作相同。術(shù)后ig給藥1次，各組分別于術(shù)后0、3、6、12 h眼后靜脈叢采血，試劑盒法檢測(cè)血清大鼠胱抑素C（CysC）和腎損傷分子-1（KIM-1）、尿中性粒細(xì)胞明膠酶相關(guān)脂質(zhì)運(yùn)載蛋白（NGAL）、全血乳酸、血清肌酐（Scr）水平；并于12 h處死每組大鼠各3只，HE染色后進(jìn)行腎組織病理觀察，免疫組化法檢測(cè)腎組織缺氧誘導(dǎo)因子（HIF）-1α水平。結(jié)果 術(shù)后3~12 h，加味生脈散低、中、高劑量組動(dòng)物血清CysC、尿NGAL、Scr值顯著低于模型組（P<0.05）；術(shù)后6~12 h，高、中、低劑量組動(dòng)物血清KIM值顯著低于模型組（P<0.05）；術(shù)后12 h，高、中、低劑量組全血乳酸值顯著低于模型組（P<0.05）。與模型組比較，加味生脈散高、中、低劑量組動(dòng)物病理變化程度輕微。模型組動(dòng)物腎組織皮、髓質(zhì)交界處彌漫性HIF-1α陽(yáng)性表達(dá)，皮質(zhì)陽(yáng)性表達(dá)明顯；加味生脈散高、中劑量組動(dòng)物腎組織外髓質(zhì)內(nèi)帶弱陽(yáng)性表達(dá)HIF-1α，皮質(zhì)無(wú)陽(yáng)性表達(dá)；低劑量組動(dòng)物腎組織外髓質(zhì)內(nèi)帶陽(yáng)性表達(dá)明顯，皮質(zhì)弱陽(yáng)性表達(dá)。結(jié)論 加味生脈散具有保護(hù)膿毒休克合并急性腎損傷大鼠腎功能的作用。

Objective To investigate the effect and mechanism of Jiawei Shengmai San powder on septic shock complicated with acute renal injury. Methods Totally 60 SPF healthy adult male SD rats were divided into three groups:control group, sham group, model group, Jiawei Shengmai San high, medium and low dose (10, 20 and 30 g/kg) group. The models of Sepsis were established by CLP in all groups except the control group. The sham group only performed the same procedure without cecal ligation and perforation. Blood samples were taken from the retroorbital vein at the time points of 0, 3, 6 and 12 h in each group, and the indexes of CYSC, KIM-1, Ngal, lactic acid and Scr were measured at different time points in each group, and three rats in each group were killed at 12 h, pathological observation of Renal Tissue and detection of HIF-1 were performed. Results The values of serum CYSC, urine Ngal and Scr in the high, middle and low dose groups of 3 to 12 h were lower than those in the model group (P<0.05). The serum Kim values in the high, middle and low dose groups of 6 to 12 h were significantly lower than those in the model group (P<0.05). The values of whole blood lactic acid in the high, middle and low dose groups of 12 h were lower than those in the model group (P<0.05). Compared with model group, the pathological changes of Jiawei Shengmai San in high, middle and low dose groups were relatively slight. There was a weak positive expression in the outer medulla of the kidney tissue in the high and middle dosage groups, but not in the cortex of the kidney tissue in the low dosage groups. Conclusion Jiawei Shengmai San has protective effect on renal function in rats with septic shock and acute renal injury.

R285.5

廣東省產(chǎn)學(xué)研重大專項(xiàng)資助（2014B090902002）；廣州市科技項(xiàng)目資助（201804010306）