Article(id=1220655530893299817, tenantId=1146029695717560320, journalId=1189982191388893191, issueId=1220655523473571972, articleNumber=null, orderNo=null, doi=10.16438/j.0513-4870.2020-0017, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=research-article, receivedDate=1578240000000, receivedDateStr=2020-01-06, revisedDate=1584288000000, revisedDateStr=2020-03-16, acceptedDate=null, acceptedDateStr=null, onlineDate=1768956557248, onlineDateStr=2026-01-21, pubDate=1597161600000, pubDateStr=2020-08-12, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1768956557248, onlineIssueDateStr=2026-01-21, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1768956557248, creator=13701087609, updateTime=1768956557248, updator=13701087609, issue=Issue{id=1220655523473571972, tenantId=1146029695717560320, journalId=1189982191388893191, year='2020', volume='55', issue='8', pageStart='1707', pageEnd='1982', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1768956555479, creator=13701087609, updateTime=1768986579152, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1220781451944051235, tenantId=1146029695717560320, journalId=1189982191388893191, issueId=1220655523473571972, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1220781451944051236, tenantId=1146029695717560320, journalId=1189982191388893191, issueId=1220655523473571972, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=1849, endPage=1854, ext={EN=ArticleExt(id=1220655531451142289, articleId=1220655530893299817, tenantId=1146029695717560320, journalId=1189982191388893191, language=EN, title=Metabolic abnormalities associated with ketamine-associated bladder toxicity based on metabolomics, columnId=1190335348761793317, journalTitle=Acta Pharmaceutica Sinica, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=

The aim of the present study was to determine the metabolic changes and possible toxic mechanisms of ketamine-associated bladder toxicity. Twenty-four male Sprague-Dawley (SD) rats were randomly allocated into a control group, a low-dose group and a high-dose group. The behavior of these rats was observed every day. In addition, the weight, 2 h urinary frequency and organ coefficient of the bladder were measured. Serum IL-6 and TNF-α levels were measured using an enzyme-linked immunosorbent assay (ELISA). Urinary metabolites were analyzed using gas chromatography-mass spectrometry (GC-MS). This research was approved by the Ethics Committee of the Animal Experiment Center of Southwest Medical University (No. 201901-98). After 12 weeks of administration, the frequency of 2 h urination and the bladder mass index were significantly different in the low-dose and high-dose groups compared with the control group. Serum IL-6 and TNF-α levels were higher than those of the control group (P < 0.05). Bladder HE staining showed that long-term administration of ketamine could induce cystitis. The concentrations of the three common differential metabolites, including 3-aminoisobutyric acid, citric acid and uric acid in the low-dose and the high-dose groups were increased compared with those in the control group. This study indicates that 3-aminoisobutyric acid, citric acid and uric acid and their related metabolic pathways may be closely related to ketamine-associated bladder toxicity.

, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=Copyright ©2020 Acta Pharmaceutica Sinica. All rights reserved., copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, authorCompany=null, fund=null, authors=null, authorsList=Zhi-gui WU, Wen-xian YIN, Hong-li LUO, Yuan-kai SI, Meng-qi SUN, Lin-chuan LIAO), CN=ArticleExt(id=1220655532763959516, articleId=1220655530893299817, tenantId=1146029695717560320, journalId=1189982191388893191, language=CN, title=基于代谢组学探索氯胺酮膀胱毒性相关的尿液差异代谢物, columnId=1190335348896011050, journalTitle=药学学报, columnName=研究论文, runingTitle=null, highlight=null, articleAbstract=

探讨长期给药诱导形成的氯胺酮性膀胱炎差异代谢物变化及可能的毒性机制。本实验以雄性Sprague-Dawley(SD)大鼠为实验动物,随机分为对照组、氯胺酮低剂量(10 mg·kg-1)和氯胺酮高剂量(50 mg·kg-1)给药组,腹腔注射给药12周,测定大鼠2 h尿频次数,膀胱质量系数,采用酶联免疫法测定血清白介素-6(interleukin-6,IL-6)和肿瘤坏死因子(tumor necrosis factor-α,TNF-α)炎症指标。基于气相色谱-质谱联用(GC-MS)技术分析大鼠尿液代谢物图谱,运用多元统计模式识别分析。本实验获得西南医科大学动物实验中心伦理委员会批准(批准号:201901-98)。结果显示给药12周后,2 h尿频次数及膀胱质量指数低剂量组和高剂量组与对照组相比具有显著差异(P < 0.05或P < 0.01);血清IL-6和TNF-α炎症指标及膀胱HE染色结果显示,长期给予氯胺酮会诱导膀胱炎;根据代谢组学分析在对照组与低剂量组之间的差异代谢物为2,3-丁二醇、3-氨基异丁酸、柠檬酸、尿酸;在对照组与高剂量组之间的差异代谢物为3-氨基异丁酸、戊糖醇、柠檬酸、D-葡萄糖酸、尿酸。本研究表明,3-氨基异丁酸、柠檬酸和尿酸为共同的差异代谢物,与对照组比较,其相对浓度呈增加趋势,且在高剂量组中,其浓度增加更加显著,表明这3种差异代谢物可能与氯胺酮性膀胱炎发生发展密切相关。

, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=版权所有©《药学学报》编辑部2020, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=xSM5ttjo0lfoAkSrb8Q5ig==, magXml=iNpl2Alr3A00gRQ0alK51Q==, pdfUrl=null, pdf=56e4EWh/q+RizPvV/QFoQA==, pdfFileSize=808914, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=5ygRogwwN9Ih5g/2IriQSg==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=cxncQSgYSnXegxSQ6EjPqg==, mapNumber=null, authorCompany=null, fund=null, authors=

廖林川, Tel:86-28-85501636, E-mail:

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West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu 610041, China, bio=null, bioImg=null, bioContent=null, aboutCorrespAuthor=null), CN=AuthorExt(id=1220655535519617494, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1220655530893299817, authorId=1220655535305707961, language=CN, stringName=廖林川, firstName=林川, middleName=null, lastName=廖, prefix=null, suffix=null, authorComment=null, nameInitials=null, affiliation=null, department=null, xref=3, address=3.四川大学华西基础与法医学院, 四川 成都 610041, bio={"content":"

廖林川, Tel:86-28-85501636, E-mail:

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廖林川, Tel:86-28-85501636, E-mail:

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Arch Biochem Biophys, 2019, 30: 82-93., articleTitle=The NLRP3 inflammasome-interleukin 1 pathway as a therapeutic target in gout, refAbstract=null), Reference(id=1220655542415053676, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1220655530893299817, doi=10.1016/j.biopha.2017.10.051, pmid=null, pmcid=null, year=2017, volume=96, issue=null, pageStart=727, pageEnd=735, url=null, language=null, rfNumber=[30], rfOrder=29, authorNames=Wu H, Zhou M, Lu G, journalName=Biomed Pharmacother, refType=null, unstructuredReference= Wu H , Zhou M , Lu G et al . Emodinol ameliorates urate nephropathy by regulating renal organic ion transporters and inhibiting immune inflammatory responses in rats[J]. Biomed Pharmacother, 2017, 96: 727-735., articleTitle=Emodinol ameliorates urate nephropathy by regulating renal organic ion transporters and inhibiting immune inflammatory responses in rats, refAbstract=null), Reference(id=1220655542536688496, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1220655530893299817, doi=10.1016/j.phymed.2018.09.009, pmid=null, pmcid=null, year=2019, volume=53, issue=null, pageStart=274, pageEnd=285, url=null, language=null, rfNumber=[31], rfOrder=30, authorNames=Lu XY, Zou W, Dong YQ, journalName=Phytomedicine, refType=null, unstructuredReference= Lu XY , Zou W , Dong YQ et al . Anti-renal fibrosis effect of asperulosidic acid via TGF-β1/smad2/smad3 and NF-κB signaling pathways in a rat model of unilateral ureteral obstruction[J]. 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Contents of IL-6 (A) and TNF-<i>α</i> (B) in serum from rats. <sup>*</sup><i>P</i> < 0.05, <sup>**</sup><i>P</i> < 0.01 <i>vs</i> Con; <sup>##</sup><i>P</i> < 0.01 <i>vs</i> Con , figureFileSmall=hF8wraq1biIpqbWu496h4Q==, figureFileBig=lqMB9I2ZkYcAfMooKOoTOQ==, tableContent=null), ArticleFig(id=1220655537646129802, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1220655530893299817, language=EN, label=null, caption=null, figureFileSmall=EpqoR5ONoCZxfLQximOOmA==, figureFileBig=qCZINKV5vDTBgg6MO3g86g==, tableContent=null), ArticleFig(id=1220655537734210194, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1220655530893299817, language=CN, label=Figure 3, caption= Histopathological changes of the bladder. Hematoxylin-eosin staining was used to examine histopathological changes. Magnification, 200× , figureFileSmall=EpqoR5ONoCZxfLQximOOmA==, figureFileBig=qCZINKV5vDTBgg6MO3g86g==, tableContent=null), ArticleFig(id=1220655537847456415, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1220655530893299817, language=EN, label=null, caption=null, figureFileSmall=6ptlHjzT8QQ1E3neRKoreA==, figureFileBig=FrGkfzoRLItpIU/VcgmFSw==, tableContent=null), ArticleFig(id=1220655538073948845, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1220655530893299817, language=CN, label=Figure 4, caption= Partial least squares-discriminant analysis (PLS-DA) score plot among different groups. A: Control group <i>vs</i> low-dose ketamine group and high-dose ketamine group; B: Control group <i>vs</i> low-dose ketamine group; C: Control group <i>vs</i> high-dose ketamine group , figureFileSmall=6ptlHjzT8QQ1E3neRKoreA==, figureFileBig=FrGkfzoRLItpIU/VcgmFSw==, tableContent=null), ArticleFig(id=1220655538195583667, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1220655530893299817, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
Metabolite HMDB RT/min VIP P FC Trend (vs control)
2, 3-Butanediol HMDB0003156 5.645 1.912 4 0.000 183 0.210 69
3-Aminoisobutyric acid HMDB0001906 9.505 2.451 3 0.001 624 0.117 72
Citric acid HMDB0000094 15.715 2.524 7 0.004 112 0.465 18
Uric acid HMDB0000289 18.504 2.075 9 0.005 461 0.327 89
), ArticleFig(id=1220655538338190009, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1220655530893299817, language=CN, label=Table 1, caption=

Differential substances between control group and low-dose ketamine group. RT: Retention time; FC: Fold change; VIP: Variable importance in the projection

, figureFileSmall=null, figureFileBig=null, tableContent=
Metabolite HMDB RT/min VIP P FC Trend (vs control)
2, 3-Butanediol HMDB0003156 5.645 1.912 4 0.000 183 0.210 69
3-Aminoisobutyric acid HMDB0001906 9.505 2.451 3 0.001 624 0.117 72
Citric acid HMDB0000094 15.715 2.524 7 0.004 112 0.465 18
Uric acid HMDB0000289 18.504 2.075 9 0.005 461 0.327 89
), ArticleFig(id=1220655538459824831, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1220655530893299817, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
Metabolite HMDB RT/min VIP P FC Trend (compared with control)
3-Aminoisobutric acid HMDB0001906 9.505 1.719 2 0.000 114 0.109 87
Pentitol HMDB0000508 13.548 1.580 4 0.000 810 2.221 00
Citric acid HMDB0000094 15.715 1.674 1 0.000 233 0.175 69
D-Gluconic acid HMDB0000625 17.201 1.791 9 0.000 029 2.521 30
Uric acid HMDB0000289 18.504 1.541 2 0.001 269 0.143 57
), ArticleFig(id=1220655538573071046, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1220655530893299817, language=CN, label=Table 2, caption=

Differential substances between control group and high-dose ketamine group

, figureFileSmall=null, figureFileBig=null, tableContent=
Metabolite HMDB RT/min VIP P FC Trend (compared with control)
3-Aminoisobutric acid HMDB0001906 9.505 1.719 2 0.000 114 0.109 87
Pentitol HMDB0000508 13.548 1.580 4 0.000 810 2.221 00
Citric acid HMDB0000094 15.715 1.674 1 0.000 233 0.175 69
D-Gluconic acid HMDB0000625 17.201 1.791 9 0.000 029 2.521 30
Uric acid HMDB0000289 18.504 1.541 2 0.001 269 0.143 57
), ArticleFig(id=1220655538656957130, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1220655530893299817, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
Compound RT/min Target ion Fragment ion 1 Fragment ion 2
3-Aminoisobutric acid 9.505 248 174 73
Pentitol 13.548 217 147 103
Citric acid 15.715 374 273 147
D-Gluconic acid 17.201 319 147 205
Uric acid 18.504 456 441 73
), ArticleFig(id=1220655538774397651, tenantId=1146029695717560320, journalId=1189982191388893191, articleId=1220655530893299817, language=CN, label=Table 3, caption=

Mass spectral information of different metabolites

, figureFileSmall=null, figureFileBig=null, tableContent=
Compound RT/min Target ion Fragment ion 1 Fragment ion 2
3-Aminoisobutric acid 9.505 248 174 73
Pentitol 13.548 217 147 103
Citric acid 15.715 374 273 147
D-Gluconic acid 17.201 319 147 205
Uric acid 18.504 456 441 73
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基于代谢组学探索氯胺酮膀胱毒性相关的尿液差异代谢物
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吴知桂 1 , 殷文贤 2 , 罗宏丽 1 , 司元楷 1 , 孙梦琦 1 , 廖林川 3
药学学报 | 研究论文 2020,55(8): 1849-1854
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药学学报 | 研究论文 2020, 55(8): 1849-1854
基于代谢组学探索氯胺酮膀胱毒性相关的尿液差异代谢物
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吴知桂1, 殷文贤2, 罗宏丽1, 司元楷1, 孙梦琦1, 廖林川3
作者信息
  • 1.西南医科大学附属医院药学部, 四川 泸州 646000
  • 2.西南医科大学附属中医院医院药学部, 四川 泸州 646000
  • 3.四川大学华西基础与法医学院, 四川 成都 610041
  • 廖林川, Tel:86-28-85501636, E-mail:

Metabolic abnormalities associated with ketamine-associated bladder toxicity based on metabolomics
Zhi-gui WU1, Wen-xian YIN2, Hong-li LUO1, Yuan-kai SI1, Meng-qi SUN1, Lin-chuan LIAO3
Affiliations
  • 1. Department of Pharmacy, Affiliated Hospital of Southwest Medical University, Luzhou 646000, China
  • 2. Department of Pharmacy, Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical University, Luzhou 646000, China
  • 3. West China School of Basic Medical Sciences and Forensic Medicine, Sichuan University, Chengdu 610041, China
出版时间: 2020-08-12 doi: 10.16438/j.0513-4870.2020-0017
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探讨长期给药诱导形成的氯胺酮性膀胱炎差异代谢物变化及可能的毒性机制。本实验以雄性Sprague-Dawley(SD)大鼠为实验动物,随机分为对照组、氯胺酮低剂量(10 mg·kg-1)和氯胺酮高剂量(50 mg·kg-1)给药组,腹腔注射给药12周,测定大鼠2 h尿频次数,膀胱质量系数,采用酶联免疫法测定血清白介素-6(interleukin-6,IL-6)和肿瘤坏死因子(tumor necrosis factor-α,TNF-α)炎症指标。基于气相色谱-质谱联用(GC-MS)技术分析大鼠尿液代谢物图谱,运用多元统计模式识别分析。本实验获得西南医科大学动物实验中心伦理委员会批准(批准号:201901-98)。结果显示给药12周后,2 h尿频次数及膀胱质量指数低剂量组和高剂量组与对照组相比具有显著差异(P < 0.05或P < 0.01);血清IL-6和TNF-α炎症指标及膀胱HE染色结果显示,长期给予氯胺酮会诱导膀胱炎;根据代谢组学分析在对照组与低剂量组之间的差异代谢物为2,3-丁二醇、3-氨基异丁酸、柠檬酸、尿酸;在对照组与高剂量组之间的差异代谢物为3-氨基异丁酸、戊糖醇、柠檬酸、D-葡萄糖酸、尿酸。本研究表明,3-氨基异丁酸、柠檬酸和尿酸为共同的差异代谢物,与对照组比较,其相对浓度呈增加趋势,且在高剂量组中,其浓度增加更加显著,表明这3种差异代谢物可能与氯胺酮性膀胱炎发生发展密切相关。

氯胺酮  /  代谢组学  /  膀胱炎  /  3-氨基异丁酸  /  柠檬酸  /  尿酸

The aim of the present study was to determine the metabolic changes and possible toxic mechanisms of ketamine-associated bladder toxicity. Twenty-four male Sprague-Dawley (SD) rats were randomly allocated into a control group, a low-dose group and a high-dose group. The behavior of these rats was observed every day. In addition, the weight, 2 h urinary frequency and organ coefficient of the bladder were measured. Serum IL-6 and TNF-α levels were measured using an enzyme-linked immunosorbent assay (ELISA). Urinary metabolites were analyzed using gas chromatography-mass spectrometry (GC-MS). This research was approved by the Ethics Committee of the Animal Experiment Center of Southwest Medical University (No. 201901-98). After 12 weeks of administration, the frequency of 2 h urination and the bladder mass index were significantly different in the low-dose and high-dose groups compared with the control group. Serum IL-6 and TNF-α levels were higher than those of the control group (P < 0.05). Bladder HE staining showed that long-term administration of ketamine could induce cystitis. The concentrations of the three common differential metabolites, including 3-aminoisobutyric acid, citric acid and uric acid in the low-dose and the high-dose groups were increased compared with those in the control group. This study indicates that 3-aminoisobutyric acid, citric acid and uric acid and their related metabolic pathways may be closely related to ketamine-associated bladder toxicity.

ketamine  /  metabolomics  /  bladder toxicity  /  3-aminoisobutyric acid  /  citric acid  /  uric acid
吴知桂, 殷文贤, 罗宏丽, 司元楷, 孙梦琦, 廖林川. 基于代谢组学探索氯胺酮膀胱毒性相关的尿液差异代谢物. 药学学报, 2020 , 55 (8) : 1849 -1854 . DOI: 10.16438/j.0513-4870.2020-0017
Zhi-gui WU, Wen-xian YIN, Hong-li LUO, Yuan-kai SI, Meng-qi SUN, Lin-chuan LIAO. Metabolic abnormalities associated with ketamine-associated bladder toxicity based on metabolomics[J]. Acta Pharmaceutica Sinica, 2020 , 55 (8) : 1849 -1854 . DOI: 10.16438/j.0513-4870.2020-0017
氯胺酮(ketamine)为苯环己哌啶的衍生物, 属NMDA (N-甲基-D-天门冬氨酸)非竞争性受体拮抗剂, 随着对氯胺酮的深入研究, 发现其是临床唯一具有镇静、镇痛和麻醉等多项药效于一体的静脉麻醉药物[1], 近年来, 小剂量氯胺酮的抗抑郁[2-4]、脑保护[5]等其他作用也突显出来。同时, 氯胺酮具有一定的致幻作用和成瘾性, 也被滥用于各种娱乐场所。近几年来, 非法滥用氯胺酮的人数呈现快速增长趋势[6]。在氯胺酮的应用越来越广泛的同时, 使用人群越来越多, 其毒副作用也越来越受到人们的高度关注。
2007年, Shahani等[7]首次报道了长期吸食氯胺酮可引起泌尿系统损伤, 特别是对膀胱的影响, 并将其称之为“氯胺酮相关性膀胱炎”。此后, 氯胺酮引起的膀胱炎逐渐引起人们的重视[8, 9]。氯胺酮性膀胱炎的主要临床表现为尿潴留、尿失禁、血尿、膀胱壁增厚、膀胱容量降低等尿道下段症状。虽然已有研究证实氯胺酮可引起泌尿系统损伤, 但其研究仍处于探索阶段, 涉及以下方面:氯胺酮及其代谢产物去甲氯胺酮的直接毒性作用损伤膀胱屏障功能障碍[10, 11]; 氯胺酮可以通过线粒体及内质网相关通路增强膀胱氧化应激作用, 从而引起膀胱细胞凋亡及泌尿道上皮屏障破坏细胞凋亡[12]; 以及相关的炎症介质等[13, 14]。代谢组学是一种研究内源性代谢产物的系统方法。该方法不仅可以诊断和监测疾病, 而且可以通过识别与疾病相关的特殊代谢产物和代谢途径, 为探索机制提供新的思路。前期对Sprague-Dawley (SD)大鼠尿液代谢组学进行了研究, 发现短期使用氯胺酮后, 部分代谢物发生了显著变化[15]。本研究采用代谢组学的方法研究氯胺酮的长期膀胱毒性, 以确定内源性代谢物的变化。这有助于解释与氯胺酮相关的膀胱炎的生成机制。
试剂与药品  甲氧胺盐酸盐(98%, 批号: 5001E07X, 美国Aldrich公司), BSTFA+1% TMCS (1 g, 批号: 60196, 美国Regis公司), 硬脂酸甲酯(99.5%, 批号: J22-A, 中国阿拉丁公司), 乙腈、吡啶、正庚烷等。氯胺酮申请备案于四川省公安局, 纯度为99.3%, 用超纯水配置成100 mg·L-1的母液备用。
实验仪器   ST8R冷冻离心机(美国Thermo Fisher公司); N-1200AS旋转蒸发集中器(日本Eyela公司); GAMMA 1-16冷冻干燥机(德国Christ公司); Agilent 7890C GC-MS和AMDIS 6.51分析软件(美国Agilent公司); SIMCA-P11.0分析软件(美国Umetrics公司)。
给药方法  雄性SD大鼠24只, 体重220±20 g, 购自成都达硕实验动物有限公司[SCXK (川) 2015-030]。适应性喂养一周, 饲养环境如下:饲育温度23 ± 2 ℃, 湿度50% ± 10%, 光照/黑暗12 h交替, 自由饮水进食。所有实验均遵照四川省实验动物管理委员会的规定进行, 符合《实验动物管理和使用指导》。本实验获得西南医科大学动物实验中心伦理委员会批准(批准号: 201901-98)。将大鼠分为给药组和对照组, 每组8只, 腹腔注射低剂量氯胺酮(10 mg·kg-1)和高剂量氯胺酮(50 mg·kg-1), 对照组给予等量生理盐水, 连续给药12周, 每天1次, 每周称重, 根据体重变化调整给药量。
大鼠一般行为观察及样本采集  每日观察大鼠行为表现, 每周记录体重, 每两周记录大鼠2 h尿频次数(在固定2 h内, 观察大鼠尿的次数, 参考文献[11]方法); 在给药12周末次给药后24 h后, 采用代谢笼收集大鼠24 h尿液, 然后麻醉大鼠, 取心血, 剥离膀胱组织肉眼观察并称重, 计算膀胱脏器系数[膀胱脏器系数=膀胱重量(g)/体重(g)×100%], 样品放置于-80 ℃冰箱冻存备检。
血清ELISA分析  用促凝管采集大鼠心血, 静置30 min, 以3 000 r·min-1离心15 min, 取上清液用于ELISA检测。IL-6和TNF-α试剂盒购于江苏南京建成生物有限公司, 按试剂盒操作说明进行操作。
膀胱组织HE染色  取同一部位的膀胱组织固定于4%多聚甲醛中, 石蜡包埋, 在一系列酒精浓度下脱水, 切片, 进行常规H.E染色。在200倍显微镜下观察染色切片(Olympus Bx53, 日本)。
尿液代谢组学分析  
样本前处理  样品根据参考文献[16]方法, 采用衍生化的方式处理, 取尿液100 μL于EP管中, 加乙腈300 μL沉淀蛋白, 4 ℃ 12 000 r·min-1离心10 min, 取上清液100 μL, 旋转蒸发浓缩至近干, 然后在冻干机中冻干过夜。加入甲氧胺盐酸盐的吡啶溶液(15 mg·mL-1) 30 μL, 密封涡旋。16 ℃下避光肟化16 h, 再迅速加入BSTFA+1% TMCS 30 μL, 于70 ℃烘箱中甲基硅烷化1 h, 冷却后, 加入内标溶液(10 μg·mL-1) 100 μL, 将所有处理好的样本溶液各取10 μL混合, 即为质量控制(QC)样本, 取上清液进GC-MS分析。
仪器参数及数据处理  色谱柱采用DB-5MS, 0.25 mm×30 m×0.25 µm; 程序升温:起始温度为60 ℃, 保持1 min, 然后以10 ℃·min-1升温至325 ℃, 最后保持10 min; 质谱接口、离子源和四极杆温度分别为280、230和150 ℃; 采用EI源, 碰撞电压设置为70 eV质谱, 全扫描模式 (m/z 50~600), 扫描速度为2 spectra/s; 采集的数据经AMDIS 6.51软件(Agilent, 美国)去卷积和进行谱峰的确证, 将与NIST 2014 (Agilent, 美国)质谱库匹配大于80%的色谱峰作为代谢物定性的标准, 进行保留时间校准、峰对齐等操作, 将数据导入Metaboanalyst进行分析, 包括:主成分分析(PCA)、偏最小二乘法-判别分析(PLS-DA)、t检验、倍数变化分析(FC)等; 差异化合物筛选标准为变量投影重要度(VIP)大于1.5以及t检验P < 0.05。
统计学分析  以均数±标准差($\bar x$ ± s)表示, 数据统计学处理采用SPSS 19.0统计学软件(version 19.0 for Windows, SPSS Inc., America)进行分析, 检验水准α=0.05, P < 0.05为差异具有统计学意义。
每2周大鼠2 h尿频次数结果见图 1A。由图可知在10周前, 对照组和低剂量给药组2 h尿频次数没有显著性差异, 在10周和12周2 h尿频次数有显著性差异(P < 0.01);高剂量组自给药8周起, 与对照组相比2 h尿频次数有显著性差异(P < 0.01)。大鼠膀胱脏器系数结果见图 1B。低剂量组与高剂量组与对照组相比都有显著性差异。
大鼠血清ELISA结果见图 2。血清IL-6 (图 2A)低剂量组与对照组差异有统计学意义(P < 0.05), 高剂量组与对照组相比差异显著(P < 0.01);血清TNF-α (图 2B)低剂量、高剂量和对照组相比都具有显著性差异(P < 0.01)。
膀胱组织病理改变见图 3。对照组(图 3A)显示膀胱正常变移上皮, 未见异常改变; 低剂量氯胺酮组(图 3B)可见膀胱变移上皮中度炎细胞浸润; 高剂量氯胺酮组(图 3C)可见膀胱变移上皮大量红细胞漏出, 伴大量中性炎细胞浸润。
以QC样本为参考, 将其各信号峰强度以变异系数(CV < 30%)为筛选条件, 共检测出72种代谢物。进一步采用PLS-DA模式识别方法进行分析。PLS-DA是一种有监督的模式识别方法, 目的是建立类别间的数学模型, 使样本间达到最大分离。PLS-DA得分图可以看到给药组大鼠尿液中的内源性代谢物与正常组相比发生了明显的变化, 见图 4。3组共同进行PLS-DA分析, 对照组与给药组呈明显分离, 低剂量给药组与高剂量给药组有小部分重合。
该PLS-DA模型采用交叉验证的方法进行分析模型的可靠性验证。在对照组和低剂量氯胺酮给药组之间, R2 = 0.995, Q2 = 0.903;在对照组和高剂量氯胺酮给药组之间, R2= 0.994, Q2 = 0.894。R2代表模型的可解释变量, Q2代表模型的可预测变量。理论上, R2Q2越接近1越好。通常R2Q2大于0.5, 并且两者差值不大(小于0.3), 则表明模型拟合较好。根据交叉验证结果显示PLS-DA模型拟合较好。
差异物质分析以PLS-DA模型的VIP > 1.5和t检验的P < 0.05, 且倍数变化(FC) > 2 (或 < 0.5)为标准筛选差异物质, 结果见表 1表 2。通过对照组和低剂量给药组、对照组和高剂量给药组分别进行分析, 发现2-氨基异丁酸、柠檬酸和尿酸这3种物质是共同的差异代谢物, 与对照组比较, 其相对浓度呈增加趋势, 且在高剂量组中的浓度增加更加显著。各差异代谢物的质谱信息图见表 3
本实验采用GC-MS联合模式识别方法、统计分析技术, 对氯胺酮性膀胱炎尿液代谢状况进行了初步探索, 发现3-氨基异丁酸, 柠檬酸和尿酸可能与氯胺酮性膀胱炎密切相关。
3-氨基异丁酸又称β氨基异丁酸, 是一种非蛋白β-氨基酸。3-氨基异丁酸参与嘧啶代谢途径[17]。胸腺嘧啶被分解成β-氨基异丁酸, 胞嘧啶可分解为尿嘧啶, 尿嘧啶可分解为N-氨甲酰-β-丙氨酸, 然后再分解为β-丙氨酸。β-丙氨酸和β-氨基异丁酸作为α-酮戊二酸转氨为谷氨酸的-NH2供体。随后的反应将产物在线粒体内进一步转化为丙二酰辅酶A或甲基丙二酰辅酶A (转化为丁二酰辅酶A并可分流至柠檬酸循环)。在氯胺酮导致的膀胱炎大鼠尿液中, 低剂量组和高剂量组中3-氨基异丁酸相对浓度增加, 表明胸腺嘧啶分解代谢被激活, β-氨基异丁酸产生增加。3-氨基异丁酸激活ROS氧化路径[18], ROS对肾小球、膀胱均有损伤作用, 促进膀胱间质纤维化。但也有报道3-氨基异丁酸可以减弱脂多糖诱导的炎症反应[19], 这与作者的研究结果不一致, 可能还需进一步深入研究。3-氨基异丁酸是细胞过表达过氧化酶增殖激活受体的转录辅助活化因子1α (PGC-1α)时分泌的一种小分子代谢产物, 通过过氧化物酶体增殖物激活受体α (peroxisome proliferator-activated receptorα, PPARα)增加脂肪酸氧化, 而引起炎症和氧化应激[20], 这可能是氯胺酮性膀胱炎机制之一。
柠檬酸是在三羧酸循环中形成的一种弱酸, 在柠檬酸裂解酶催化下需消耗ATP将柠檬酸裂解回草酰乙酸和乙酰辅酶A[21], 乙酰辅酶A和柠檬酸共同激活乙酰辅酶A羧化酶, 促进丙二酸单酰辅酶A, 这与β-氨基异丁酸代谢途径又联系起来, 相互促进。另一方面, 柠檬酸在顺乌头酸酶的催化下转化为异柠檬酸, 在顺乌头酸酶的作用下进一步反应。而在本实验中柠檬酸相对于对照组相对浓度增加, 提示可能柠檬酸裂解酶或顺乌头酸酶、异柠檬酸脱氢酶相关柠檬酸代谢的酶失活, 氯胺酮可能就作用于相关代谢靶标。柠檬酸相关代谢途径可由睾酮和催乳素调节[22], 关键调节酶是线粒体天冬氨酸氨基转移酶、丙酮酸脱氢酶和线粒体乌头酸酶。氯胺酮长期使用可能导致尿路上皮细胞分泌释放多种神经递质, 包括ATP、NO、乙酰胆碱来调节膀胱逼尿肌舒缩[23]。膀胱膨胀扩张引起膀胱黏膜上皮细胞释放ATP, 这与柠檬酸循环的能量代谢相关, 而细胞外ATP通过P2X3受体介导并激活小型神经节细胞, 释放传入神经冲动, 引起尿意。反过来, ATP还可以激活尿路上皮下神经末梢的P2X3受体, 释放神经冲动引起膀胱收缩[24]。氯胺酮相关性膀胱炎其损害机制与尿路上皮屏障通透性改变有关。其致病机制可能与氯胺酮通过某通路, 引起ZO-1蛋白异常表达[25], 继而影响微丝运动, 紧密连接受损, 膀胱尿路上皮屏障破坏有关。
尿酸是一种杂环嘌呤衍生物, 是嘌呤代谢的最终氧化产物。长期氯胺酮滥用可能影响机体对嘌呤能神经递质释放的抑制作用, 膀胱传入神经冲动过分活跃, 从而导致膀胱逼尿肌过度活动[26]。长期氯胺酮滥用引起尿路上皮细胞嘌呤能神经递质过量分泌释放, 也可能是重要的发病机制, 膀胱上皮屏障由氨基葡聚糖(GAG)、上皮细胞之间的紧密连接以及特化的伞状细胞组成。黄嘌呤等氧嘌呤在黄嘌呤氧化酶的作用下氧化成尿酸, 尿酸酶进一步将尿酸氧化成尿囊素。在该实验结果中显示尿酸在氯胺酮给药组中显著上升, 提示黄嘌呤氧化酶被激活, 尿酸酶被抑制, 使得尿酸合成增加, 分解减少。一些转运蛋白参与调节尿酸水平。其中包括控制尿酸重吸收的尿酸转运蛋白1 (URAT1), 有机离子转运蛋白(OAT), 如OAT1和OAT3[27], 以及依赖于ATP的尿酸转运蛋白(MRP4)[28]。URAT1被认为是调节尿酸水平的最关键因素。慢性高尿酸症可由肾脏肾小球滤过率降低、尿酸盐排泄量减少或肾小管吸收增加引起。高尿酸与许多疾病和条件有关, 包括痛风、高血压、心血管疾病、心肌梗死、中风和肾病。尿酸也被认为是炎症的重要引发剂和放大剂[29], 因而也可能是引起氯胺酮性膀胱炎的因素之一。
研究表明, 尿酸可被树突状细胞、巨噬细胞和中性粒细胞等固有免疫细胞的TLRs识别, 通过IL-1受体与髓系分化因子88 (MyD88)结合形成复合物, 募集IRAK并使之活化, 通过下游激酶级联反应, 激活转录因子NF-κB, 引起促炎细胞因子基因的转录和表达, 诱导产生细胞因子如IL-1β、IL-6、IL-18及TNF-α[30]。IL-1β与尿酸钠结晶诱导的炎症反应密切相关, IL-1β作用于上皮细胞使其分泌趋化因子和黏附因子, 引起间质中炎症细胞的浸润和活化, 扩大炎症反应; 另研究[31]表明IL-1β能够促进微血管内皮细胞表达α-SMA和I型胶原, 诱导该细胞发生间充质转化, 引起间质纤维化形成。IL-lβ抑制剂或受体拮抗剂可减少组织炎细胞浸润, 改善尿酸引起的炎症反应。
综上, 3-氨基异丁酸、柠檬酸和尿酸及其相关代谢途径可能与氯胺酮诱导的膀胱炎密切相关。
作者贡献:廖林川设计整个实验方案; 吴知桂、殷文贤和司元楷进行实验操作; 罗宏丽和孙梦琦进行数据分析; 吴知桂撰写论文; 廖林川修改论文。
利益冲突:无利益冲突。
  • 国家自然科学基金面上项目(81373239)
  • 西南医科大学附属医院博士启动基金(18104)
  • 西南医科大学校级课题(00031260)
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2020年第55卷第8期
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doi: 10.16438/j.0513-4870.2020-0017
  • 接收时间:2020-01-06
  • 首发时间:2026-01-21
  • 出版时间:2020-08-12
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  • 收稿日期:2020-01-06
  • 修回日期:2020-03-16
基金
国家自然科学基金面上项目(81373239)
西南医科大学附属医院博士启动基金(18104)
西南医科大学校级课题(00031260)
作者信息
    1.西南医科大学附属医院药学部, 四川 泸州 646000
    2.西南医科大学附属中医院医院药学部, 四川 泸州 646000
    3.四川大学华西基础与法医学院, 四川 成都 610041
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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