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目的:观察早期糖尿病在膀胱尿动力学和cajal样细胞上的病理学改变,探讨其发生机制及病理演绎过程。方法:建立早期糖尿病豚鼠模型40只(病变组),以正常豚鼠20只作对照(对照组),饲养10周后行膀胱最大收缩压、漏尿点压等尿动力学指标测定。然后将两组豚鼠膀胱制作成冷冻切片行免疫荧光染色及激光共聚焦显微镜观察。结果:10周后,与对照组比较,病变组膀胱最大容量(P<0.05)、漏尿点压(P<0.01)、顺应性(P<0.05)、剩余尿量(P<0.01)增加,而膀胱静息压(P<0.01)、最大逼尿肌压(P<0.05)下降,激光共聚焦显微镜下见糖尿病组膀胱逼尿肌中cajal样细胞数量减少(P<0.01),cajal样细胞二聚体消失(P<0.01)。结论:糖尿病膀胱病变豚鼠早期有尿动力学异常,cajal样细胞数量减少并伴有该细胞二聚体结构消失,提示早期糖尿病膀胱病变是高糖环境下发生了具有起博功能的cajal样间质细胞异常,从而使逼尿肌功能障碍及尿动力学发生改变;而真正起逼尿功能的平滑肌细胞失去该细胞起博而处于一种待激发的“休眠状态”。因此,临床上应针对这种情况进行干预,以控制病情的进一步恶化。
OBJECTIVE: To observe the pathological changes of urinary bladder urodynamics and cajal-like cells in early stage of diabetes mellitus, and to explore its mechanism and pathological process. Methods: Forty diabetic guinea pigs with pathological changes were established. Twenty normal guinea pigs were used as controls (control group). Urine dynamic parameters such as maximum systolic pressure and urinary leakage pressure were measured after feeding for 10 weeks. Then two groups of guinea pig bladder were made into frozen sections by immunofluorescence staining and laser confocal microscopy. Results: After 10 weeks, compared with the control group, the maximal bladder capacity (P <0.05), urinary leakage pressure (P <0.01), compliance (P <0.05) and residual urine volume (P <0.01) (P <0.01), and the maximum detrusor pressure (P <0.05) decreased. The number of cajal-like cells in the bladder detrusor muscle decreased in the diabetic group (P <0.01) by confocal laser scanning microscope. The number of cajal-like cells Dimers disappeared (P <0.01). CONCLUSION: Early diabetic guinea pigs with diabetic cystopathy have abnormal urodynamics, decreased number of cajal-like cells and diminished dimer structure, which suggests that cajal-like interstitial germinal vesicle Cell abnormalities, so that detrusor dysfunction and urodynamic changes; while the real smooth muscle cells from urinary function loss of the cell boiled and in a kind of “dormancy” to be excited. Therefore, we should intervene in this situation in order to control the further deterioration of our condition.