两种手术方式治疗2型糖尿病机制的研究  

Mechanism of Roux-en-Y gastric bypass and gastric banding on type 2 diabetes

作　　者：孙晓芳 王道荣 赵长勇 

机构地区：[1]扬州大学临床医学院内分泌科,江苏扬州225001 [2]扬州大学临床医学院普外科

出　　处：《中华内分泌外科杂志》2010年第3期155-160,共6页Chinese Journal of Endocrine Surgery

基　　金：江苏省卫生厅指导性科研课题（No.Z200709）

摘　　要：目的 比较Roux-en-Y胃旁路术（RYGB）与胃束带术（GB）对链脲佐菌素诱发2型糖尿病（T2DM）大鼠的治疗效果,探讨其机制.方法 40只成模T2DM大鼠分为RYGB组10只;GB组10只;饮食控制组（F组）10只;对照组（C组）10只.检测术前、术后第1、2、3、4、8和16周的空腹血糖、空腹胰岛素样生长因子-1（IGF-1）、空腹血浆瘦素、空腹血浆胰岛素水平、体重及进食量、手术时间、死亡率.结果 GB组术后第16周空腹血糖下降至（12.6±3.7） mmol/L、空腹血浆胰岛素水平升至（58.7±9.2） mU/L、空腹血浆瘦素降至（14.6±3.3） pg/ml、体重（212.6±15.1） g/只,与术前相比差异均有统计学意义（P〈0.01）;RYGB组术后第16周空腹血糖降至（8.6±3.7） mmol/L,血浆IGF-1升至（148.6±7.3） ng/L,空腹血浆胰岛素升至（74.7±9.2） mU/L,空腹血浆瘦素降至（14.1±3.5） pg/ml、空腹体重降至（200±15.1） g/只,与术前相比差异有统计学意义（P〈0.01）;F组与GB组比较,空腹血浆胰岛素和空腹血浆瘦素在术后第3、4周及体重在术后第3周相比均有统计学意义（P〈0.05）,两组手术时间、血糖差异无统计学意义（P〉0.05）.结论 RYGB组较GB组在同时间的空腹血糖和血浆胰岛素改善更明显;血浆胰岛素和血浆瘦素在RYGB组与GB组都起降糖作用.饮食控制及术后血浆胰岛素,空腹血浆瘦素水平改变在GB组发挥重大作用,IGF-1升高可能在Roux-en-Y术后血糖改善中起重要作用.在手术时间上,死亡率GB组优于RYGB组.Objective To clarify mechanism of Roux-en-Y gastric bypass （RYGB） and gastric banding on diabetes induced by STZ injection. Methods 40 rats with STZ induced diabetes were randomly allocated into Roux-en-Y gastric bypass （RYGB） group （group RYGB, n=10）, gastric banding group （group GB, n=10 ）, diet control group （group F, n=10）, control group （group C,n= 10）. The fasting blood glucose, the fasting insulin IGF-1, the fasting Plasma leptin, the fasting plasma insulin level, the weight and the food-intake, the operation time, the death rate were measured and recored before and after operation on 1st , 2nd, 3 rd ,4th, 8th and 16 th week postoperatively. Results The fasting blood glucose of the group of gastric banding（GB） descended to （12.6±3.7） mmol/L, the fasting plasma insulin rose to （58.7±9.2） mIU/L, the fasting plasma leptin descended to （14.6±3.3） pg/ml, the weight was （212.6±15.1） g.There were significant differences between before and after operation on 16 th week（P〈0.01）. The fasting blood glucose of the group of Roux-en-Y （RYBG） descended to 8.8±4.9 mmol/L in the sixteenth week, the fasting insulin IGF-1 rose to （148.6±7.3） ng/L, the fasting plasma insulin rose to （14.1±3.5） pg/ml, the fasting plasma leptin descended to 14.1±3.5 pg/ml, the weight was （200±15.1） g. There were significant differences between before and after operation 16 th week （P〈0.01）. There were significant differences of the fasting plasma insulin and the the fasting plasma leptin between group F and group C during the 3 rd to 4th week after operation （P〈0.05）. Compared the weight of the group F and the group C on the third week of operation, there were significant differences （P〈0.05）, and there were no significant differences in other time. The fasting blood glucose of the group F and the group C had no sig-nificant differences between before and after operation.（P〈0.05）. Conclusions The fasting blood glucose and the fasting insulin level

关 键 词：ROUX-EN-Y胃旁路术 胃束带术 T2DM 

分 类 号：R587.1[医药卫生—内分泌]