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水蛭抗家兔血瘀证作用机制及归经的初步研究
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摘要
水蛭是一味传统的中药,有着复杂的化学成分和广泛的药理作用。大量的研究发现水蛭具有抗血栓、抗肿瘤、抗纤维化、抗炎等多种药理作用。随着科学技术的日益发展,人们对水蛭的研究日趋深入,研究领域日趋扩大,其药理作用正在被更多的挖掘出来并为人们所利用,被广泛用于临床,使其越来越成为预防、治疗多种疾病的重要药物,其应用前景广阔。通过对水蛭的全面深入的研究,水蛭这一传统的中药正焕发出新的活力,更好的为人类的健康服务。
     随着心脑血管等血瘀证疾病发病率的日益升高,对其病因及诊断方法的研究也越来越受到中西医学者的关注。医用动物模型作为现代医学研究的重要方法之一,也越来越多的应用到各种疾病的研究中,对疾病诊治与药物作用机制的研究起到了重要的作用。血瘀证,是临床上最常见的证候之一,是由瘀血所引起的各种临床综合表现。目前对血瘀证模型的制备多从其病因病机制备模型,在造模时有采用单一因素造模的,也有采用复合因素造模的。大量的研究表明,血瘀证涉及多个复杂的病理生理变化,与血液流变学、血脂代谢异常、血管内皮细胞损伤等均有着密切的联系。
     中药归经是中药理论中的精髓,是在千百年来大量的临床实践中累积和总结出来的,它是分析和阐述中药功效和作用机制的重要依据,对中医临床实践有重要的指导作用,因此对中药归经的研究对于更进一步研究药物的药性、作用机制以及指导临床用药有着重要的意义。
     本研究通过复合因素(饥饿+高脂+注射肾上腺素)制备家兔血瘀证模型,造模期40d,造模结束后将模型组随机分为高、中、低三个剂量组和模型组,水蛭组分别给予不同剂量水蛭(0.30g/kg、0.15g/kg和0.075g/kg)治疗30d。通过对血瘀证家兔血清中血脂水平(总胆固醇TC、甘油三酯TG、低密度脂蛋白胆固醇LDL-C、高密度脂蛋白胆固醇HDL-C)、血浆中内皮功能指标(内皮素ET-1、血管紧张素AngII、一氧化氮NO)、脂质过氧化指标(丙二醛MDA)、肝脏中脂质过氧化指标(超氧化物歧化酶SOD、丙二醛MDA)进行测定;采用实时荧光定量PCR对血瘀证家兔肝脏中载脂蛋白E基因(ApoE)、低密度脂蛋白受体基因(LDL-R)、内皮素基因(ET-1)、内皮型一氧化氮合酶(eNOS)四个基因表达量的变化进行研究,以探讨水蛭抗血瘀证的作用机理。同时采用体内活性物质观测法对血瘀证家兔和正常家兔心、肝、脾、肺、肾、胃、大肠、小肠、胆中SOD、MDA含量进行测定来研究中药水蛭的归经作用。主要研究结果如下:
     1)造模结束时,模型组家兔血脂水平发生异常,血清中TC、TG、LDL-C显著升高,与对照组相比差异显著(P<0.05),经不同剂量水蛭治疗后发现,血瘀证家兔三个指标明显下降,与模型组差异显著(P<0.05),说明水蛭能够对血瘀证家兔血脂水平进行调节,以第30d、低剂量组水蛭效果最好。
     2)造模结束时,模型组家兔内皮功能发生异常,血浆中ET-1、AngII含量显著高升高,NO含量显著降低,与对照组相比差异显著(P<0.05),经不同剂量水蛭治疗后发现,血瘀证家兔三个指标明显恢复,与模型组相比差异显著(P<0.05),说明水蛭能够对血瘀证家兔内皮功能损伤进行调节,以给药第30d,低剂量组水蛭效果最好。
     3)造模结束时,模型组家兔体内存在脂质过氧化反应,血浆和肝脏中MDA明显升高、肝脏中SOD含量显著降低,与对照组相比差异显著(P<0.05),经不同剂量组水蛭进行治疗后,两个指标均呈现恢复的趋势,与模型组相比差异显著(P<0.05),说明水蛭能够对血瘀证家兔脂质过氧化反应进行抑制,其中以给药第30d、低剂量组水蛭效果最好。
     4)造模结束时,模型组家兔肝脏中ApoE基因、LDL-R基因表达量显著下降,与对照组相比差异显著(P<0.05),经不同剂量水蛭进行治疗后,血瘀证家兔肝脏中ApoE、LDL-R基因表达量显著升高,与模型组相比差异显著(P<0.05),说明水蛭能够对血脂类代谢相关基因表达进行调控,其中对ApoE基因和LDL-R基因调节作用分别以给药第30d、高剂量组水蛭、低剂量组水蛭效果最好。
     5)造模结束时,模型组家兔肝脏中ET-1基因表达量显著升高、eNOS基因表达量显著下降,与对照组相比差异显著(P<0.05),经不同剂量水蛭进行治疗后,血瘀证家兔肝脏中ET-1基因表达量显著下降、eNOS基因表达量显著升高,与模型组相比差异显著(P<0.05),说明水蛭能够对内皮功能相关基因表达进行调控,其中以给药第30d、低剂量组效果最好。
     6)水蛭不论对血瘀证家兔还是正常家兔各个脏器中SOD、MDA含量的影响均有一定的选择性,这种选择性基本上与水蛭传统归经相一致,但水蛭对血瘀证家兔肝脏中MDA含量影响的选择性更符合传统的水蛭归经理论,结果提示水蛭归肝经,对肺、肾、胃、胆具有一定的选择性。
     综上,采用复合因素多因素(饥饿+高脂+肾上腺素)能够成功制备家兔血瘀证模型,造模结束时模型组家兔血脂水平代谢紊乱、内皮功能异常、机体内发生脂质过氧化反应,模型组家兔肝脏中ApoE基因、LDL-R基因、eNOS基因表达量显著下降,ET-1基因表达量显著升高,与对照组相比差异显著(P<0.05),经过不同剂量组水蛭进行治疗后,三个剂量组均能对血瘀证家兔血脂水平、内皮功能、脂质过氧化反应进行调节,能够显著上调血瘀证家兔肝脏中ApoE基因、LDL-R基因、eNOS基因的表达量,显著下调ET-1基因的表达量,说明水蛭能够治疗家兔血瘀证模型,其作用机制可能是:1)调节血脂代谢水平及血脂代谢相关基因LDL-R、ApoE基因的表达量;2)调节内皮功能及相关基因ET-1、eNOS基因的表达量;3)抑制体内脂质过氧化反应。采用体内活性物质观测法对水蛭的归经进行了初步研究,结果表明,水蛭对血瘀证家兔还是正常家兔各个脏器中SOD、MDA含量的影响均有一定的选择性,水蛭的这种选择性调节能基本反应水蛭的归经,提示采用体内活性物质观测法研究中药的归经具有一定的可行性。
Hirudo is a traditional Chinese medicine with complex chemical constituents and widely pharmacologicfunctions. It has been showed that hirudo had the effect of antithrombosis, antitumor, anti-fibrosis and anti-inflummatory and so on. With the development of science and technology, the researchs of hirudo have been doneprofoundly, the research field has been expendied continuously, the pharmacologic functions was much more minningand was widely applied to clinical, hirudo has increasingly become an important drug which can prevent and treatmany diseases, and with prospect of application. As a traditional medicine, hirudo is shinning out new energy throughthe deep and comprehensive studies and it will provide better services to human health.
     The study of etiology and diagnose method of cardio-cerebrovascular diseases get more and more attention fromChinese and Western medicine scholar, because of the escalating incidence of it. As an important method of modernmedical research, animal model has been used more and more in various diseases, which has played an important rolein the studies of the diagnosis of diseases and mechanism of drug action. Blood stasis syndrome was a majorsymptom in clinic, which include various clinical comprehensive features caused by blood stasis. The modelpreparation of blood stasis ayndrome was almost from the etiology, the methods including single factor and alsocomplex factors. Abundant researches indicated that blood stasis syndrome involving in many physiological andpathological processes, which has a close relation to the hemorheology, abnormal lipid metabolism, and vascularendothelial cell injury and so on.
     The channel tropism of Traditional Chinese Medicine was the essence of the theory of Chinese Medicine, whichwas accumulated and summarized from a large amount clinic research, which was an important basis for analyzingand describing the effect and mechanism of Chinese medicine, and played an important role in clinic research. So ithas the important significance to study the character, mechanism of medicine, and guide clinic.
     In this study, the blood stasis syndrome rabbit models induced by complex factors (starvation+high-fat feeding+adrenaline) were established in40d. After modeling, model rabbits randomly divided into four groups, three differentlevels Hirudo groups and model group. Rabbits in Hirudo groups were daily administered with Hirudo (0.30,0.15and0.075g/kg) for30days. The mechanism of Hirodu anti-blood stasis syndrome was studied through determinationof blood lipid lever in serum(Total cholesterol, TG; Triglyceride TC; Low density lipoprotein cholesterol, LDL-C;High density lipoprotein choleaterol, HDL-C), endothelin function indexes in plasma(endothelin-1, ET-1;AngiotensinII, AngII; Nitric oxide, NO), lipid peroxidation indexes in plasma (Malondialdehyde, MDA) and inliver(Malondialdehyde, MDA; Superoxide dismutase, SOD) of blood stasis syndrome rabbits; Realtime PCR wasused to study the levels of expression of Applipoprotein E(ApoE), Low density lipoprotein receptor(LDL-R),Endothelin-1(ET-1) and Endothelial nitricoxide synthase(eNOS) in livers of blood stasis syndrome rabbits. At the same time, the channel tropism of Traditional Chinese Medicine was studed through deteminating the contents ofMDA、SOD in heart, liver, spleen, lung, kidney, stomach, colorectal, intestinal and bile of blood stasis syndromerabbits and nomal rabbits by the obervation method of the active materials in vivo. The main results are as fallows:
     1) After modeling, the blood lipid of model rabbits was abnomal, compared with control group, the levels of TC,TG, LDL-C in serum of model rabbits were significantly increased(P<0.05), three indexes decreased significantlycompared with model rabbits after treatment of hirudo(P<0.05). The results suggest that hirudo could regulate theblood lipid of blood stasis syndrome rabbits, and in the30d, the low dose of hirudo has the best effect.
     2) After modeling, the endothelial function of model rabbits was abnomal, compared with control group, thelevels of ET-1, AngII in plasma of model rabbits were significantly increased, the level of NO in plasma wassignificantly decreased (P<0.05), all of three indexes retuned to normal level compared with model rabbits aftertreatment of hirudo (P<0.05). The results suggest that hirudo could regulate the endothelial dysfunction of blood stasissyndrome rabbits, and in the30d, the low dose of hirudo has the best effect.
     3) After modeling, the lipid peroxidation reaction has happened in vivo of model rabbits, compared with controlgroup, the levels of MDA in plasma and livers of model rabbits was significantly increased, the level of SOD in liverswas significantly decreased (P<0.05), all of two indexes retuned to normal level compared with model rabbits aftertreatment of hirudo (P<0.05). The results suggest that hirudo could inhibit the lipid peroxidation reaction of bloodstasis syndrome rabbits, and in the30d, the low dose of hirud has the best effect.
     4) After modeling, compared with control group, the gene expression of ApoE and LDL-R in livers of modelrabbits were significantly decreased (P<0.05), the gene expression of ApoE and LDL-R increased significantlycompared with model rabbits after treatment of hirudo (P<0.05). The results suggest that hirudo could regulate thegene expression of gene relevant with blood lipid in livers of blood stasis syndrome rabbits, and in the30d, the highdose and the low dose of hirudo has the best effect to regulate the gene expression of ApoE gene and LDL-Rgene,respectively.
     5) After modeling, compared with control group, the gene expression of ET-1in livers of model rabbits weresignificantly increased, the gene expression of eNOS in livers of model rabbits were significantly decreased (P<0.05),the gene expression of ET-1decreased significantly, and the gene expression of eNOS increased significantlycompared with model rabbits after treatment of hirudo (P<0.05). The results suggest that hirudo could regulate thegene expression of gene relevant with endothelial function in livers of blood stasis syndrome rabbits, and in the30d,the low dose of hirudo has the best effect.
     6) Hirudo has definite selectivity to levels of MDA and SOD in each organ whther in blood stasis syndromerabbits or nomal rabbits, which was basically agreement with the traditional channel tropism of Chinese medicine, andthe selectivy of MDA of hirudo in blood stasis syndrome rabbits was much more according with traditional channeltropism of hirudo, the results suggest that hirudo belong to liver meridian, and has definite selectivity to lung, kidney,stomach and colorectal.
     In summary, the results of this study suggest that complex factors (starvation+high-fat feeding+adrenaline) canestablished model of rabbits blood stasis syndrome, After modeling, compared with control group, the blood lipid,endothelial function of model rabbits was abnomal, and the lipid peroxidation reaction has happened in vivo of model rabbits, the gene expression of ApoE, LDL-R and eNOS gene in livers of model rabbits were significantly decreased,the gene expression of ET-1in livers of model rabbits were significantly increased(P<0.05), After treatment, hirudocould regulate the blood lipid, endothelial function of blood stasis syndrome rabbits, and could inhibit the lipidperoxidation reaction of blood stasis syndrome rabbits, could up-regulate gene expression of ApoE, LDL-R, eNOSgene in livers of blood stasis syndrome rabbits, and down-regulate gene expression of ET-1gene in livers of bloodstasis syndrome rabbits. The results suggest that hirudo has the effect of anti-blood stasis syndrome, the mechanism asfollows:1) Regulate the blood lipid liver and gene expression of blood metabolism related gene LDL-R and ApoE;2)Regulate the endothelial function and gene expression of related gene ET-1and eNOS;3) Inhibit the peroxidationreaction of rabbits. The channel tropism of Traditional Chinese Medicine was studed through deteminating thecontents of active material, the results showed that Hirudo has definite selectivity to levels of MDA and SOD in eachorgan whther in blood stasis syndrome rabbits or nomal rabbits, and the selectivity was basically agreement with thetraditional channel tropism of Chinese medicine. The results suggest that the method of deteminating the contents ofactive material has the feasibility of studying the channel tropism of Traditional Chinese Medicine.
引文
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