不同胃转流手术对2型糖尿病大鼠降血糖作用研究  

Comparison of blood glucose lowering effects of different gastric bypass procedures in rats with type 2 diabetes

作　　者：韩俊岭[1] 王跃生[1] 

机构地区：[1]佳木斯大学第一附属医院普外一科,黑龙江佳木斯154003

出　　处：《中国普通外科杂志》2012年第10期1249-1254,共6页China Journal of General Surgery

基　　金：黑龙江省自然科学基金资助项目(D201127)

摘　　要：目的:探讨不同胃转流术(RYGB)对2型糖尿病大鼠的降血糖作用及其机制。方法:将50只用链脲佐菌素成功制备2型糖尿病模型的SD大鼠随机均分为5组:A组(假手术组),B组(旷置十二指肠RYGB组),C组(旷置近段空肠RYGB组),D组(旷置十二指肠和近段空肠RYGB组),E组(无旷置的胃-空肠短路组)。测定各组大鼠术前及术后1,3,6,12周的体质量、空腹血糖(FBG)、糖依赖性胰岛素释放肽(GIP)及胰高血糖素样肽1(GLP-1)的变化。E组大鼠12周后再次开腹,于胃窦下闭合十二指肠,旷置十二指肠和近段空肠,观察再次术后1,3,6周FBG,GIP,GLP-1的变化。结果:与术前比较,术后1周各组体质量均无明显改变(均P>0.05),A,B,C组术后3,6周仍无明显变化(均P>0.05),但术后12周明显增加,且A组增加最为明显(均P<0.05),D,E组术后3,6周体质量有所降低(均P<0.05),至术后12周基本接近术前水平(均P>0.05)。与术前比较,A组术后各时间点FBG,GIP,GLP-1均无明显改变(均P>0.05);D组FBG水平在术后1周开始明显且逐渐降低,B,C,E组FBG水平在术后3周开始明显且逐渐降低(均P<0.05),同时间点比较,D组FBG降低最为明显,E组最小(均P<0.05),B,C组间无明显差异(均P>0.05);B,C,D组GIP值术后1周开始明显并逐渐降低,且同时间点D组降低最为明显(均P<0.05),B,C组间无明显差异(均P>0.05),而E组GIP值术后时间点均无明显改变(均P>0.05);D,E组GLP-1值术后1周开始均明显并逐渐升高,B,C组GLP-1值术后3周开始均明显并逐渐升高,且同时间点D,E组GLP-1升高程度明显大于B,C组(均P<0.05);E组再次手术后FBG和GIP水平较再次术前均明显降低(均P<0.05),而GLP-1水平无明显变化(均P>0.05)。结论:旷置十二指肠和近段空肠RYGB对2型糖尿病大鼠有较好的降血糖作用,其机制与术后食物不经过十二指肠和近段空肠引起GIP低分泌以及食物过早到达远段空肠和回肠引起GLP-1高分泌有关。Objective： To investigate the blood sugar lowering effects of different gastric bypass procedures in type 2 diabetic （T2DM） rats and the mechanisms involved. Methods： Fifty SD rats with T2DM induced by streptozotocin were equally randomized into 5 groups： Group A （sham operation control）, group B （gastric bypass with exclusion of the duodenum）, group C （gastric bypass with the exclusion of the proximal jejunum）, group D （gastric bypass with the exclusion of the duodenum and proximal jejunum） and group E （gastrojejunal diversion without intestinal exclusion）, respectively. The body weight gain and levels of fasting blood glucose （FBG）, glucose-dependent insulin-releasing peptide （GIP） and glucagon-like peptide-1 （GLP-1） in rats of each group were determined before and 1 week, 3, 6 and 12 weeks after operation. Twelve weeks later, rats in group E underwent a second laparotomy to exclude the duodenum and proximalejunum by occluding the duodenum distal to the gastric antrum, and the levels of FBG, GIP and GLP-1 were determined 1 week, 3 and 6 weeks after the second operation. Results： Compared with the preoperative values, the body weight of the rats in each group showed no obvious change one week after surgery （all P〉0.05）, which in group A, B and C still had no noticeable change 3 and 6 weeks after surgery （all P〉0.05）, but significantly increased 12 weeks after surgery and was most marked in group A （all P〈0.05）, but in group D and E were somewhat decreased 3 and 6 weeks after surgery （all P〈0.05） and close to the preoperative levels 12 weeks after surgery （both P〉0.05）. The levels of FBG, GIP and GLP- 1 in group A showed no obvious alterations at each postoperative time point compared with those before surgery （all P〉0.05）. The FBG levels decreased significantly and gradually from one week after surgery in group D, and decreased significantly and gradually from 3 weeks after surgery in group B, C and E （all P〈0.05）, which was mo

关 键 词：糖尿病 2型/外科学 胃转流术 肠促胰岛素类 胰高血糖素样肽1 大鼠 

分 类 号：R656.6[医药卫生—外科学]