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研究生:林怡彣
研究生(外文):Yi Wen Lin
論文名稱:敗血症早期對大鼠骨骼肌葡萄糖利用之性別差異
論文名稱(外文):Gender difference in glucose utilization of skeletal muscle during early-phase sepsis
指導教授:陳君侃陳君侃引用關係樓迎統樓迎統引用關係
指導教授(外文):J. K. ChenY. T. Lau
學位類別:碩士
校院名稱:長庚大學
系所名稱:生物醫學研究所
學門:工程學門
學類:生醫工程學類
論文種類:學術論文
論文出版年:2009
畢業學年度:97
論文頁數:90
中文關鍵詞:敗血症高血糖胰島素阻抗骨骼肌雌激素
外文關鍵詞:sepsishyperglycemiainsulin resistanceskeletal muscleestrogen
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敗血症(sepsis)在發生早期即可觀察到葡萄糖代謝異常的現象,其原因為體內受到壓力所引起的激素分泌改變,促進體內分解作用而使得葡萄糖釋出血中並造成主要作用器官-骨骼肌的胰島素訊號受阻,無法活化下游葡萄糖轉運蛋白4 (GLUT4),降低葡萄糖攝取;另一方面,骨骼肌中的肝醣分解增加,加劇了高血糖(hyperglycemia)的情形。研究指出,敗血症併發高血糖程度越嚴重會造成病情惡化與死亡率的提升。雌激素(estrogen)在許多疾病上皆扮演著保護的作用,且能降低胰島素阻抗並參與維持體內葡萄糖的恆定,而敗血症中亦可發現女性存活率高於男性。我們以盲腸結紮與穿刺術(cecal ligation and puncture,CLP)誘發大鼠敗血症,導致體內高血糖和骨骼肌胰島素阻抗現象,探討敗血症早期所引發的高血糖程度是否有性別差異?並探討此差異性的可能原因。另一方面,雌激素又會透過何種調控機制,穩定敗血症早期所導致的葡萄糖代謝異常?由實驗結果顯示,不同性別的大鼠在敗血症誘發後約3小時均有高血糖現象發生,其中雄鼠血糖又顯著高於雌鼠血糖,且雌激素可以有效降低敗血症早期的高血糖現象。進而觀察CLP後3小時體內腎上腺素(epinephrine)和腎上腺皮質醇(cortisol)在血中的濃度,發現在敗血症雄鼠與雌鼠的這些反向調控激素(counter-regulatory hormone)在體內分泌量大幅增加,且增加程度相似,而雌激素對其分泌量並無顯著影響。另外以[3H]-2-deoxyglucose檢測胰島素刺激後骨骼肌對血中葡萄糖攝取的情形,發現雄鼠骨骼肌的胰島素敏感度(insulin sensitivity)明顯低於雌鼠,而雌激素可有效降低敗血症早期所引起的胰島素阻抗,並能夠顯著增加雄鼠CLP後骨骼肌中的肝醣含量。這些實驗結果顯示,在敗血症早期雄鼠體內產生的胰島素阻抗現象較雌鼠嚴重,導致骨骼肌無法正常攝取循環血中的葡萄糖,同時骨骼肌中的肝醣消耗量也較雌鼠為高,故使得雄鼠體內的高血糖現象較雌鼠嚴重,而此結果也可能與死亡率上的性別差異雄鼠高過雌鼠相關;給予補充雌激素治療可增加骨骼肌對胰島素的敏感度,並提高肝醣含量,降低敗血症早期的高血糖程度。
The initial abnormality of glucose metabolic response during sepsis can be affected by the counter-regulatory hormones (i.e., catecholamines and cortisol) increase. Hyperglycemia and insulin resistance in skeletal muscle occurred. Studies have shown that sepsis-induced stress hyperglycemia is an important risk marker of morbidity and mortality. Estradiol (E2) plays a protective role in sepsis and it regulates insulin actions and maintains glucose homeostasis. We had also found that the survival rate of females is better than males during sepsis. Sepsis was induced in Sprague-Dawley rats of both genders by cecal ligation and puncture (CLP). We found that CLP-induced hyperglycemia in all animals at 3 hours later and it was severer in males than females. E2 administration (10mg/kg, i.p.) reduced the level of blood glucose. In order to investigate the mechanisms of hyperglycemia and potential effects of E2, we than explored the gender difference and E2 effect on glucose uptake and glycogen storage in skeletal muscle during early-phase sepsis. We measured the blood concentrations of epinephrine and cortisol, and found that the two counter- regulatory hormones were sharply increased by CLP but E2 did not reverse it. We next assessed insulin-stimulated glucose uptake in skeletal muscle during early sepsis, and the results showed that insulin sensitivity (EC50) of [3H]-2-deoxyglucose (2-DG) uptake was reduced in both extensor digitorum longus (EDL) muscle and soleus (SOL) muscle from male rats and was significantly worse than female rats. Glycogen content was diminished in skeletal muscle of male rats only at 3 hour post-CLP. E2 administration to male rats could improve these CLP-induced defects except epinephrine and cortisol. In view of these findings, we infer that early sepsis-induced insulin resistance in male rats is more serious than female rats, and result in aberrant glucose uptake in skeletal muscle, expediting muscle glycogen break down. Taken together, these changes caused higher blood glucose level in males than females, and similar pattern was also observed for mortality. E2 treatment also appeared to ameliorate the disturbance of glucose metabolism and to reduce the mortality of sepsis.
目錄

指導教授推薦書
口試委員會審定書
授權書...................................................iii
誌謝......................................................iv
中文摘要...................................................vi
英文摘要.................................................viii
第一章.緒論
1.1敗血症(sepsis) .........................................1
1.2敗血症對葡萄糖代謝的影響...................................2
1.3敗血症造成骨骼肌對胰島素的阻抗性(insulin resistance)........3
1.4敗血症之性別差異(gender difference).......................5
1.5雌激素對體內葡萄糖代謝的恆定作用(homeostasis)...............6
1.6雌激素受體(estrogen receptor,ER)對葡萄糖代謝的調節作用.....8
第二章.研究目的與假說......................................10
第三章.研究材料與方法
3.1 實驗材料
3.1.1 實驗動物.............................................11
3.1.2 實驗藥品與試劑.......................................11
3.1.3 實驗儀器.............................................12
3.2 實驗方法
3.2.1 實驗動物模式.........................................13
3.2.2 實驗動物分組.........................................14
3.2.3 母鼠動情週期(estrus cycle)的觀察......................15
3.2.4 生化值檢測...........................................15
3.2.5 骨骼肌中肝醣(glycogen)含量之分析......................18
3.2.6 血漿中胰島素(insulin)濃度之分析.......................18
3.2.7 血漿中雌二醇(estradiol)濃度之分析.....................19
3.2.8 血漿中腎上腺素(epinephrine)濃度之分析..................19
3.2.9 血漿中腎上腺皮質醇(cortisol)濃度之分析.................20
3.2.10 骨骼肌對胰島素刺激後葡萄糖攝取能力之分析................21
3.2.11 統計分析............................................22
第四章.實驗結果
4.1比較雄鼠與雌鼠在各時間點的存活率(Survival rate)............23
4.2 CLP對雄鼠與雌鼠生化參數之影響及雌激素的調控作用
4.2.1 肝功能損傷情形.......................................23
4.2.2 腎功能損傷情形.......................................23
4.3 CLP對雄鼠與雌鼠體內代謝之影響及雌激素的調控作用
4.3.1 脂質代謝情形.........................................24
4.3.2 葡萄糖代謝情形.......................................24
4.4 CLP對公鼠與母鼠血中雌二醇(estradiol,E2)濃度之影響........26
4.5 CLP對公鼠與母鼠血漿中反向調控激素(counter-regulatory hormone)濃度之影響及雌激素的調控作用.........................26
4.6 CLP影響雄鼠與雌鼠骨骼肌對胰島素刺激所引發的葡萄糖攝取反應及雌激素的調控作用
4.6.1CLP影響比目魚肌(SOL)對胰島素的敏感性及雌激素的調控作用....27
4.6.2CLP影響伸趾長肌(EDL)對胰島素的敏感性及雌激素的調控作用....29
第五章.討論
5.1 敗血症早期高血糖對大鼠死亡率的影響及雌激素的調控作用........31
5.2敗血症早期對大鼠體內反向調控激素的影響及雌激素的調控作用......33
5.3 敗血症早期對骨骼肌胰島素阻抗的影響及雌激素的調控作用........35
5.4 敗血症早期對骨骼肌中肝醣含量的影響及雌激素的調控作用........37
5.5 敗血症早期對雌激素濃度的影響.............................40
第六章.結論................... ...........................42
參考文獻...................................................62


圖表目錄

表一.雄鼠與雌鼠手術後SHAM組與CLP組在各個時間點(3、6、9、15小時)的存活率....................................................44
圖一.CLP早期對雄鼠與雌鼠血漿中天門冬胺酸轉胺酶(AST)濃度之影響..45
圖二.CLP早期與晚期對雄鼠與雌鼠血漿中丙胺酸轉胺酶(ALT)濃度之影響........................................................46
圖三.CLP早期對雄鼠與雌鼠血漿中尿素濃度之影響..................47
圖四.CLP早期對雄鼠與雌鼠血漿中肌酸酐濃度之影響................48
圖五.CLP早期對雄鼠與雌鼠血漿中膽固醇濃度之影響................49
圖六.CLP早期對雄鼠與雌鼠血漿中三酸甘油脂濃度之影響.............50
圖七.雌激素對CLP早期雄鼠與雌鼠血漿中葡萄糖濃度之影響...........51
圖八.雌激素對CLP早期雄鼠與雌鼠血漿中乳酸濃度之影響.............52
圖九.雌激素對CLP早期雄鼠與雌鼠骨骼肌中肝醣含量之影響...........53
圖十.CLP早期對雄鼠與雌鼠血漿中胰島素濃度之影響................54
圖十一.CLP早期對雄鼠與雌鼠血漿中雌二醇濃度之影響..............55
圖十二.雌激素對CLP早期雄鼠與雌鼠血漿中腎上腺素(epinephrine)濃度之影響......................................................56
圖十三.雌激素對CLP早期雄鼠與雌鼠血漿中腎上腺皮質醇(cortisol)濃度之影響....................................................57
圖十四.雌激素對CLP早期雄鼠與雌鼠比目魚肌(SOL)在不同濃度胰島素刺激所引起的葡萄糖攝取反應之影響.................................58
表二.CLP早期雄鼠與雌鼠比目魚肌(SOL)在給予不同濃度胰島素刺激後,引起50%葡萄糖最大攝取反應所需之胰島素濃度(EC50) 、最大的反應速率(Vmax),以及雌激素對二者之影響...............................59
圖十五.雌激素對CLP早期雄鼠與雌鼠伸趾長肌(EDL)在不同濃度胰島素刺激所引起的葡萄糖攝取反應之影響.................................60
表三.CLP早期雄鼠與雌鼠伸趾長肌(EDL)在給予不同濃度胰島素刺激後,引起50%葡萄糖最大攝取反應所需之胰島素濃度(EC50) 、最大的反應速率(Vmax),以及雌激素對二者之影響...............................61
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