10

10 Homeostasis
Homeostasis
and
and excretion
excretion
 10.1 Homeostasis keeps the
internal environment constant.

• Keeping this internal environment

constant is called homeostasis 稳
态、内稳态 .
 Homeostasis is very important.

• Keeping a constant temperature of around

37°C helps enzymes to work.
• Keeping a constant amount of water means
that your cells are not damaged by absorbi
ng or losing too much water by osmosis.
• Keeping a constant amount of glucose mean
s that there is always enough fuel for resp
iration.
• The nervous system and various
endocrine glands are involved, and so
are the kidneys.
 The control of body
temperature
l0.2 Mammals and birds are homeothermic.
• homeothermic 恒温的
mammals and birds
• poikilothermic 变温的
all invertebrates, all fish, amphibians
两栖动物 and reptiles 爬行动物
• The energy homeothermic animals us
e to generate the heat to keep their
bodies warm comes from food. This m
eans that homeothermic animals have
to eat much more food than poikiloth
ermic ones.
 10.3 Humans control
their body temperature.
• The hypothalamus keeps a constant
check on the temperature of the
blood flowing through it. It also
receives nerve impulses from
receptors in your skin which are
sensitive to the temperature of your
environment.
• If the temperature of your blood is
too low, the hypothalamus sends
impulses along nerves to various
parts of your body to increase heat
production, and to reduce heat loss
from your skin.
• If the temperature is i high, then im
pulses are sent to reduce heat produ
ction, and increase heat loss. The sys
tem is very efficient, and - as long a
s you are well - your body temperatu
re rarely varies by more than 0.5~C o
r so.
10.4 Human skin structure is
related to function.

• increase or decrease rate at which h

eat is lost from your body to the air,
which helps with temperature regulat
ion
• the top layer ： epidermis 表皮
• the lower layer ： dermis 真皮
• Malpighian layer 生发层
• keratin 角蛋白
• cornified layer 角质层
• melanin 黑色素
• hair follicle 毛囊
• sebaceous gland 皮脂腺
• sebum 皮脂
• sweat pore 汗孔
• sweat gland 汗腺
• hair erector muscle 立毛肌
 Question

• Explain the meaning of the terms

(a) homeothermic, and
(b) poikilothermic.
10.6 The dermis has many
functions.

• Most of the dermis is made of connec

tive tissue 结缔组织 . This tissue con
tains elastic fibres.
• Sweat is mostly water, with small
amounts of salt and urea dissolved in
it. It travels up the sweat ducts, and
out onto the surface of the skin
through the sweat pores. As we will
see, sweat helps in temperature
regulation.
• The dermis contains blood vessels,
and nerve endings. The nerve endings
are sensitive to touch, pain, pressure
and temperature, so they help to
keep you aware of changes in your
environment.
• Underneath the dermis is a layer of
fat. This is made up of cells which co
ntain large drops of oil. This layer hel
ps to insulate your body, and also act
s as a food reserve.
10.7 The skin reacts when
you are too cold.
• Firstly, the impulses make the
erector muscles attached to your
hair follicles contract, which makes
the hairs stand on end. If you were a
furry animal, this would provide you
with a thick layer of hair, trapping
air - which is an excellent insulator -
next to your skin.
• A second effect of the impulses from the hypot
halamus is more useful in conserving heat. The im
pulses make the muscles around the arterioles, w
hich supply blood to the capillaries near the surf
ace of your skin, contract. This closes off these
arterioles and stops blood flowing along this path
way. This called vasoconstriction 血管收缩 . The b
lood now has to go through the capillaries which l
ie below the fat layer. The fatty tissue is a good
insulator, so this reduces amount of heat which i
s lost by radiation from your blood to the air. Yo
ur skin feels cold - but your blood will stay war
m.
• There are other responses, which do
not involve your skin, which happen w
hen your blood is too cold. You will pr
obably shiver. Shivering is a very fast
， random contraction and relaxatio
n of muscles, which generates heat to
warm your blood. Metabolic reaction
s in the liver may speed up, again gen
erating extra heat.
 10.8 The skin reacts
when you are too warm.
• The erector muscles relax, so that the hai
rs lie flat against the skin, no longer trappi
ng as much air and allowing more heat to b
e lost by radiation.
• The muscles constricting the arterioles re
lax, so the blood is free to flow through th
e surface capillaries. This brings it close to
the surface of the skin, so that it can lose
more heat by radiation. This is called vasod
ilation 血管舒张 .
• The sweat glands begin to secrete
sweat. This is a id made from blood
plasma, containing mostly water and
some salt and a little urea. It flows
from the glands, through the sweat
ducts and onto the surface of the
skin.
 10.9 Temperature regulation
involves negative feedback.
• So, all the time, the hypothalamus is monit
oring small changes in the temperature of
your blood. As soon as it rises above norma
l, actions take place that help to reduce th
e temperature. Then, as soon as the hypot
halamus senses the lowered temperature, i
t stops these actions taking place and star
ts off another set of actions that help to r
aise the blood temperature.
• negative feedback 负反馈
• The term 'feedback' refers to the fact
that, when the hypothalamus has made yo
ur skin take action to increase heat loss, in
formation about the effects of these actio
ns is 'fed back' to it, as it senses the drop
in the blood temperature. It is called 'nega
tive' because the information that the hoo
d has cooled stops the hypothalamus makin
g your skin do these things.
 Question
• Polar bears live in very cold climates.
Using your general knowledge and
reference books explain what special
adaptations polar bears have to help
them to keep warm.
The control of blood glucose
content
10.10 G1ucose is needed for
respiration.
• Glucose concentration in the blood is
normal around 100mg of glucose in ev
ery 100cm3 of blood. This is controlle
d by the pancreas and the liver.
10.11 The pancreas secretes
insulin and glucagon.
• Most of the pancreas made up of cells w
hich secrete pancreatic juice, which flow
s along the pancreatic duct into the duo
denum ， where it helps in digestion .
• But dotted around in the pancreas are gr
oups of a different kind of cell; the grou
ps are called islets of Langerhans 胰岛 .
T[ cells secrete the hormones insulin 胰
岛素 and glucagon 胰高血糖素 .
• The cells in the islets of Langerhans
constant monitor the amount of gluco
se in the blood. If this level rises too
high, then they secrete insulin. If th
e blood glucose level falls too low, the
y secrete glucagon.
 10.12 The liver changes the
amount of glucose in the blood.
• Insulin and glucagon are carried arou
nd the body ， in solution in blood pla
sma. Both of them affect the behavio
ur of the liver cells.
 Insulin 胰岛素
• Insulin makes the liver change glucos
e into the polysaccharide glycogen 糖
原 , which it stores inside the cells. I
nsulin also increases the rate at whic
h the liver cells use up glucose in resp
iration. This reduce amount of glucos
e in the blood.
 Glucagon 胰高血糖素
• Glucagon makes the liver release gluc
ose into the blood, so increasing the
blood glucose level. The glucose that
the liver releases is made by breakin
g apart the glycogen molecules store
d in its cells.
10.13 Lack of insulin causes
sugar diabetes.
• Some people’s pancreases do not prod
uce enough in. If this happens, it is di
fficult to control the amount of gluc
ose in the blood. This disease, called
diabetes mellitus 糖尿病 .
• 糖尿病是一种综合症，是由于胰岛素绝
对缺乏或胰岛素的生物效应降低引起体
内代谢失调及高血糖。
 糖尿病目前发病情况：

• 随着人们生活水平的提高，饮食结构
• 的改变，近年来糖尿病发病率逐年上升
，
• 其中最快的是发展中国家。
• 我国糖尿病发病率由来已久 0.
67%(80 年 ) 上升至 3.2%(96 年 ) ，中
国现有糖尿病患者估计约 4000 万。
 全球糖尿病人已超过 1.9 亿 , 糖尿
病最多的国家是印度 , 其次是中国 ， 第三
是美国 (6%) 。
发病率最高的是南太平洋岛国瑙鲁
，
50 岁以上的人群几乎 2 个人就有 1 人患糖
尿病。
• If the person is diabetic, almost all t
he glucose will go into the bloodstrea
m 血流 and taken round the body.
• Very high blood glucose levels can da
mage brain cells, causing coma 昏迷 a
nd possibly death.
• The extra glucose in the blood is exc
reted by the kidneys.
• If there is no insulin in the body, the
n the liver and muscles will not build u
p stores of glycogen. So later, when t
he blood glucose levels have dropped
again, there will be no reserves to dr
aw on. The blood glucose may drop to
a very low level, again possibly causin
g coma and death.
• In another form of diabetes mellitus
, the pancreas does still make insulin,
but the liver cells do not respond to i
t. The symptoms are just the same as
if no insulin is made at all.
• Neither form of diabetes can be cure
d, but they can be controlled. Most p
eople with diabetes can remain health
y by eating small amounts of sugary o
r starchy foods at regular intervals.
Some, however, need to inject thems
elves with insulin each day.
糖尿病治 疗
1. 输液要尽早进行

通常用生理盐水。

如无心力衰竭 2 小时内输入 1000~2000ml.

第一个 24 小时输液总量 4000~5000ml 。

当血糖降至 13.9mmol/L 左右是改输葡萄糖液

加胰岛素。
2. 小剂量胰岛素：

生理盐水加入胰岛素 ( 另开一路注射 ) ：
每小时每公斤体重 0.1U 的胰岛素 (4-6u\h)
；

在治疗过程中，需每 1~2 小时查血糖、

电解质、尿糖、尿酮等。

当血糖下降、尿酮消失、病人能进食，改
为皮下注射胰岛素。
3. 纠正电解质及酸碱紊乱：

钾应及时补充 ( 病人几乎都有不同程度缺钾 )
。
碱尽量不补 ;

当 PH 值低至 7.1~7.0 时，并有深大呼吸时，

给予补碱治疗；

5% 碳酸氢钠 50ml ，根据病情相应追加。

4. 防治并发症：

注意预防和治疗休克、感染、心力衰竭
、

肾功能衰竭、脑水肿等。
糖尿病慢性并发症：
（一）大血管病变 :

主要是动脉粥样硬化，引起冠心病、
脑血管病、肾动脉硬化、肢体动脉硬化等。
 冠心病和脑血管病造成较高的死亡
率，

下肢血管病变严重时可引起糖尿病足
，表现为足部溃疡、大庖、坏疽、溃
疡等。
（二）微血管病变

1 、糖尿病肾病：

常以尿蛋白为标志，通过尿常规检查或
尿微量白蛋白、 B2 微球蛋白检查而发现
。

以后逐渐出现肾功能不全，是 1 型糖尿
病的主要死亡原因。
糖尿病肾病发生、发展分五期

1 期：糖尿病早期，肾脏体积增大。

2 期：肾小球毛细血管基底膜增后。

3 期：早期肾病，出现微量白蛋白尿。

4 期：临床肾病， 24 小时尿蛋白 >0.5g

。

5 期：尿毒症。
2 、 糖尿病性视网膜病变：

10 年以上的糖尿病病人，大部分合并

程度不等的视网膜病变，最后可引起失明
。

眼底病变往往和糖尿病肾病并存。
视网膜病变按眼底改变分六期：
1 期：微血管瘤，出血。

2 期：微血管瘤，出血并有硬性渗出。

3 期：出现棉絮壮软性渗出。

4 期：新生血管形成，玻璃体出血。

5 期：机化物增生。

6 期：继发性视网膜脱离，失明。
3 、糖尿病性心肌病

心脏微血管病变和心肌代谢紊乱引
起

糖尿病心肌病 .

表现为心力衰竭、心率失常、心源性休克
。
（三）神经病变

周围神经病变最常见 .

常表现为末梢神经炎，造成感觉异常，分
布如袜子或手套状，伴麻木、灼热、刺痛
等。
 常引起植物神经病变，如腹泻或便秘、

心动过缓或过速；出汗异常，多汗

或少汗；尿潴留、尿失禁、阳萎。
（四）糖尿病足

因末稍神经病变、足部供血不足 和细
箘感染引起。

表现为足部疼痛、潰痒、水疱、肢端
坏疽，统称糖尿病足。
Questions ：
• Why do body cells need glucose?
• In healthy humans, the blood contains
60 – 110 mg of glucose per 100cm3 of blood.
Which gland secretes the hormones which
are responsible for keeping this level fairly
constant?
• The graph in Fig 10.6 shows the changes in blood
glucose level after a meal.

Explain the shape of the graph between (a) A and B,

(b) B and C, and (c) C and D.
• People with one form of the disease
diabetes mellitus cannot make insulin.
Why is it dangerous for diabetics to
eat a meal containing a lot of sugar?

• The regulation of blood glucose levels

is one example of homeostasis. What
is homeostasis, and why is it
important?
 Excretion
10.14 Excretion is the removal
of waste substances.
• The metabolic reactions taking place in cells co
nstantly produce waste products, such as carbo
n dioxide. Some of these waste products can d
amage the cells - they are toxic 毒素 . Such tox
ic substances must be removed from tile body.
The removal of toxic waste materials and pr
oducts of metabolism is called excretion 排泄
.
• Carbon dioxide 二氧化碳
This is made by all cells, in respira
tion. It is transported in blood plasm
a to the alveoli of the lungs, where it
is excreted in the air you breathe ou
t.
• Bile pigments 胆色素
These are made in the liver, from
the haemoglobin 血红蛋白 in old red
blood cells. They are carried in bile in
to the duodenum, and excreted in the
faeces 粪便 .
• Urea 尿素
This is made in the liver, from exc
ess proteins. It is carried in blood pla
sma to the kidneys, where it is excre
ted in urine. It contains nitrogen 氮 ,
so it is a nitrogenous 含氮的 excreto
ry product.
10.15 Excess proteins are
converted to urea.
• If you have eaten more than you need, the
n some of them must be changed into some
thing else.
• Enzymes in the liver split up each amino aci
d molecule. The part containing the energy
is kept, turned into carbohydrate or fat, a
nd stored. The rest, which is the part whic
h contain nitrogen, is combined with carbon
dioxide and turned into urea. This process
is called deamination 去氨基 .
 氨基

Deamination 去氨基
• The urea dissolves in the blood plasm
a, and is taken to the kidneys to be e
xcreted. A small amount is also excre
ted in sweat.
How urea is made?
• Protein in food is taken into the
alimentary canal.
• The protein molecules are broken
down to amino acids during digestion.
• The amino acids are absorbed into
the blood and taken to the liver in
the hepatic portal vein.
• Amino acids that are needed are
released into the circulation.
• Amino acids that are not needed are
deaminated, into carbohydrate and a
mmonia.
• The carbohydrates are used or store
d in the liver.
• The ammonia is converted into urea.
• The urea to be excreted and the ami
no acids to be used by the body are t
aken away by the blood.
 1 、 Converts excess amino acids into urea and c
arbohydrate, in a process called deamination
2 、 Controls the amount of glucose in the blood,
with the aid of the hormones insulin and glucag
on
3 、 Stores carbohydrate as the polysaccharide
glycogen
4 、 Makes bile
5 、 Breaks down old red blood cells, storing the
iron, and excreting the remains of the pigments
： in bile
6 、 Breaks down hormones and harmful substanc
es such a alcohol
7 、 Stores vitamins D and A
8 、 Makes cholesterol, which is needed to make
and repair
Questions ：
 The human excretory system
10.16 The kidneys are part of t
he excretory system.

• kidney 肾：
two ， near the back of the ab
domen, behind the intestines
• Ureter 输尿管
• Bladder 膀胱
排泄系统的基本结构：

肾（一对） 生成尿
输尿管（一对） 输送尿
膀胱 暂存尿
尿道 排出尿
腔静脉 主动脉

横膈

肾动脉
肾静脉
左肾
输尿管

膀胱
括约肌
尿道
10.17 Urine is made by filt
ration and reabsorption.
• The function of the kidneys is to tak
e unwanted substances from the bloo
d and to pass them on to the bladder,
to be excreted.
• Blood is brought to
the kidneys in a
branch of the renal
artery. The blood is
filtered into tiny
tubules aside the
kidneys. All of the
glucose, and some of the salts, that have
gone into the tubules are taken back, or
reabsorbed 重吸收 , into the blood.
• The remaining fluid in the tubules is
water with urea and some salts dissol
ved in it. This fluid is called urine 尿 .
尿液的形成
10.18 The bladder stores uri
ne.
• The ureters 输尿管 take urine to the
bladder.
• The bladder 膀胱 stores urine. It ha
s stretchy walls, so that it can hold q
uite large quantities.
• Leading out of the bladder is a tube cal
led the urethra 尿道 .
• There is a sphincter
muscle at the top of the
urethra, which is usually
tightly closed. When the
bladder is full, the
sphincter muscle opens,
so that urine flows along
the urethra and out of the body.
10.19 Kidney machines can do
the work of damaged kidneys.

• Complete failure of the kidneys allow

s urea and other waste products to b
uild up in the blood. It also means tha
t the amount of water in the body is
not regulated. This will cause death u
nless treated.
• kidney transplant 肾移植
• kidney machine 人工肾
• dialyser 透析仪、透析机
• 透析疗法原理
　　透析疗法和肾移植都是终末期肾病（尿毒症）替
代治疗的方法，与肾移植不同的是，透析是通过人
工的方法代替丧失功能的肾脏。
透析疗法是应用半透膜的特性清除血液中的毒
性物质。半透膜的特性是对于不同物质的通透性有
着选择性，有些物质可以通过，有些物质不能通过。
如果半透膜两侧的液体浓度不同，水分就会从低浓
度侧流向高浓度侧，这种作用就叫渗透作用。而一
些小分子如尿素可以通过半透膜，也可以自高浓度
一次向的浓度一侧移动，从而达到两侧的平衡。透
析就是利用这个原理来达到净化血液的功效，在透
析中，半透膜的一侧是血液，另一侧是透析液，血
液中含有较高浓度的有毒代谢产物如尿素、肌酐和
过多的水分；而透析液中没有这些毒素成分，水分
也比较少，却含有较高浓度的营养成分，当二者流
过透析膜两侧时，血液中的毒性成分就会通过半透
膜进入透析液，相反透析液中的营养成分也可以进
入血液，这样就可以达到净化血液的效果。 flash
透析
 肾移植手术简介
• 一、要了解肾移植手术，就必须先了解移植相关的一
些基本知识：
• 器官移植：将某一个体的器官（部分、一个或几个）用手
术的方法移植到其自体体内或另一个体的某一部位称为器
官移植
供体：指提供肝脏、肾脏等移植器官的个体，供体又分为
活体供者和尸体供者，活体供者多为亲属或器官捐献者；
尸体供者多为意外死亡、脑死亡者
受体：指接受外来器官的个体，也就是接受移植的患者
自体移植：供体和受体为同一个体
同种异体移植：供者和受者同一种属如人与人之间，但不
同个体
原位移植：切除受体原来的器官，将供体的器官移植于所
切除器官原来位置，如肝脏移植多数是原位移植
异位移植：是将供体的器官移植至另一位置，此位置并非
该器官的正常解剖位置，如肾移植就是异位移植
• 二、了解了移植的基本知识，我们来看肾移植
手术：
　　肾移植手术可以概括为：供肾手术和植肾
手术。
　　 1 ． 供肾手术
　　肾脏的供体有活体供肾和尸体供肾，供肾
手术就是指从供体或尸体上获取供肾脏并加以
修整。
　　 1 ）活体供肾
　　活体供肾，多在亲属之间进行，一般是父
母为子女提供移植器官。活体供肾的获取是在
适当的麻醉下，经腰部斜切口，在保证供者安
全的情况下切取的。
• 2 ）尸肾的获取
　　尸肾的获取一般是在短时间内，通过腹部
大切口，同时切除双侧肾脏，然后加以分离，
每个肾脏经过修整后移植给一位患者。
• 3 ）供肾的灌注
　　供肾获取后，必须立
即用专用的灌注液进行灌
注，将供肾血管内的血液
冲洗干净，防止血栓形成
和减少术后排斥的机会。
• 4 ）供肾的修整
　　从供体获得肾脏，多带有很多脂肪
、一些小的血管分支，这些过多的脂肪
和小的血管分支需要在低温下进行修剪
和结扎。至此供肾手术结束，低温保存
，等待移植。
• 2 ． 植肾手术
　　目前肾移植，多为
异位肾移植，很少进行
原位移植。异位肾移植
的移植位置多为双侧髂
窝，一般是左侧供肾移
植到右侧髂窝，右侧供
肾移植到左侧髂窝，但
也有的移植医生认为不
必区分，全部移植在右
侧髂窝。
• 在麻醉条件下，取下腹
部弧形切口，逐层分离
显露髂血管，充分暴露
髂总动脉、髂外静脉、
髂内动脉，然后将供肾
静脉与髂外静脉行端侧
吻合，供肾动脉与髂内
动脉行端端吻合，或供
肾动脉与髂外动脉行端
侧吻合，最后将输尿管
种植于膀胱顶部。
• 虽然目前透析可以在某种意义上代替肾
脏的功能，但是肾脏的很多功能是透析
所不能达到的，如内分泌功能（促红素
的分泌、维生素 D 的活化等），而且透
析对患者的饮食、生活、工作等有很多
限制。相比之下，肾移植不仅可以完全
恢复肾脏的功能，而且可以象正常人一
样生活，生活质量有了很大的提高。
Questions ：

• Which blood vessels bring blood to th

e kidneys?
• What is urine?
• Where arc (a) ureters, and (b) the ur
ethra found?
• Look at Fig lO.1 1.
• (a) Why is the blood passed through
the dialyser in many small channels in
stead of one large one?
• (b) Why might it be dangerous if an a
ir bubble gets into the patient's bloo
d?
• (c) Give two reasons why a successful
kidney transplant is better than trea
tment on a kidney machine.
• 排泄（ excretion ） : 机体在新陈代谢过程中
产生的一些终产物、摄入量超过机体需要的物
质及进入机体的各种异物，经血液循环到达排
泄器官而排出体外的过程。

• 排遗（ egestion ）：食物中不能被消化的、

或未被消化的残渣掺以细胞各种分泌物等，排
出体外的过程。由消化器官完成。

• 排泄的过程同时也是保持体液稳定的过程。