Roux-en-Y胃旁路术对2型糖尿病大鼠肝脏糖异生的影响  

Influence of gastric bypass surgery on hepatic gluconeogenesis in type 2 diabetic Goto Kakizaki rats

作　　者：伍松[1] 唐均成[1] 邹洪[1] 闫洪涛[1] 陈涛[1] 黎冬暄[1] 汤礼军[1] 

机构地区：[1]成都军区总医院全军普通外科中心,610083

出　　处：《中华胃肠外科杂志》2012年第11期1142-1145,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：全军临床高新技术重大项目（2010gxjs040）

摘　　要：目的探讨Roux-en-Y胃旁路术对2型糖尿病大鼠肝脏糖异生的影响及意义。方法将40只GotoKakizaki（GK）大鼠按随机数字表法分为Rollx-en-Y胃旁路术组（A组，20只）和假手术组（B组，20只）。分别于术前及术后1、2、4周行口服葡萄糖耐量实验（OGYr）。并记录体质量。于术前及术后第4周测定两组大鼠糖化血红蛋白（HbAlc）水平。术后第4周处死大鼠获取肝脏组织,采用反转录聚合酶链反应和Westernblot技术检测肝脏组织葡萄糖6磷酸酶（G-6-P）、磷酸烯醇式丙酮酸激酶（PEPCK）的mRNA及蛋白相对表达量。结果术后1、2、4周，A组大鼠平均空腹血糖分别为6．5、4．9和4．7mmol／L，而B组分别为10-3、10．4和12．5mmol／L。两组比较差异均有统计学意义（均P〈0．05）；A组灌胃后2h血糖分别平均为8．3、6．4和5．5mmol／L，B组为21．4、23．8和24．7mmol／L，两组比较差异均有统计学意义（均P〈0．05）。A组术后第4周HbAlc为（6．8±1．0）％，低于B组的（7．9±0．8）％（P〈0．05）。A组术后4周肝脏G-6-P和PEPCK的mRNA相对表达较B组分别降低了21．0％和25．9％，蛋白表达水平也相应降低（均P〈0．05）。PAS染色示肝脏糖原沉积明显增多。结论Roux-en-Y胃旁路术后肝脏糖异生关键酶的mRNA相对表达和蛋白含量明显降低。肝脏糖异生减少．这可能是该术式的降糖机制之一。Objective To investigate the influence and significance of gastric bypass surgery on hepatic gluconeogenesis in type 2 diabetic Goto Kakizaki （GK） rats. Methods Forty GK rats were randomly divided into Roux-en-Y gastric bypass group （group A） and sham operation group （group B）. Differences in glucose tolerance experiment（OGTT） at preoperative and postoperative 1, 2 and 4 weeks were compared and weight was recorded. Glycated hemoglobin levels were measured preoperatively and 4 weeks postoperatively. The animals were sacrificed 4 weeks after surgery and liver tissues were harvested to detect the relative expression of mRNA and protein of glucose 6 phosphatase （G-6-P） and phosphoenol pyruvate kinase （PEPCK） with RT-PCR and Western blot. Results Fasting blood glucose levels were 6.5, 4.9, and 4.7 mmol/L in group A, and were 10.3, 10.4, and 12.5 mmol/L in group B, and the differences between two groups were statistically significant（P〈0.05）. The blood glucose level at 2 h after stomach lavage were 8.3, 6.4 and 5.5 mmol/L in group A, and were 21.4, 23.8 and 24.7 mmol/L in group B at postoperative 1, 2, 4 weeks, and the differences between two groups were statistically significant（P〈0.05）. The glycosylated hemoglobin at postoperative 4 weeks was（6.8±1.0）%, significantly lower than that in group B [（7.9±0.8）%, P〈0.05]. Hepatic G-6-P and PEPCK mRNA relative expression at postoperative 4 weeks was reduced by 21.0% and 25.9% respectively as compared to group B, and the protein expression reduced as well. Immunohistochemistry showed that hepaticglycogen sedimentary in group A increased significantly. Conclusion The relative mRNA and protein level of key enzymes of hepatic gluconeogenesis are significantly decreased after Roux-en-Y gastric bypass surgery and hepatic gluconeogenesis is reduced, which may be a potential mechanism of the decrease of blood glucose.

关 键 词：ROUX-EN-Y胃旁路术 2型糖尿病 Goto Kakizaki大鼠 肝脏糖异生 

分 类 号：R656.6[医药卫生—外科学]