3种不同减重手术方式治疗肥胖合并糖尿病肾病大鼠的疗效差异对比分析  

Comparative analysis of the therapeutic effects of three different weight-loss surgery methods on obese rats with diabetic nephropathy

作　　者：舒畅 姚立彬 洪健 朱孝成 SHU Chang;YAO Libin;HONG Jian;ZHU Xiaocheng(Graduate School of Xuzhou Medical University,Xuzhou,Jiangsu 221004,P.R.China;Department of Gastrointestinal Surgery,Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221004,P.R.China)

机构地区：[1]徐州医科大学研究生院,江苏徐州221004 [2]徐州医科大学附属医院胃肠外科,江苏徐州221002

出　　处：《中国普外基础与临床杂志》2023年第9期1063-1072,共10页Chinese Journal of Bases and Clinics In General Surgery

基　　金：徐州医科大学附属医院发展基金面上项目(项目编号:XYFM2021023)。

摘　　要：目的对比分析袖状胃切除术(sleeve gastrectomy,SG)、胃旁路术(Roux-en-Y gastric bypass,RYGB)及袖状胃切除+双通路转流术(sleeve gastrectomy with transit bipartition,SG+TB)3种减重手术方式对肥胖合并糖尿病肾病大鼠的减重降糖疗效及肾病缓解情况的差异。方法60只SD雄性大鼠按平均体质量随机化选取其中12只采用标准饮食(脂肪热量12%)喂养作为正常对照组(NC组),其余48只采用高脂饮食(脂肪热量40%)喂养1个月并联合低剂量1%链脲佐菌素方法诱导建立肥胖合并糖尿病肾病大鼠模型,随后随机均分为SG组、RYGB组、SG+TB组和假手术组。在术前和术后1~6个月每月称量体质量和进食量并检测禁食6 h后的空腹血糖(fasting blood glucose,FBG)水平;同时于术前和术后第1和第6个月时进行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)和胰岛素耐量试验(insulin tolerance test,ITT)以及尿微量白蛋白肌酐比值(urea albumin creatinine ratio,UACR)、血清肌酐(serum creatinine,Scr)和血尿素氮(blood urea nitrogen,BUN)的检测,最后取大鼠肾脏组织观察其病理学改变。结果SG组、RYGB组和SG+TB组术后1~6个月时的体质量和进食量均低于假手术组(P<0.05);RYGB组和ST+TB组的体质量在术后1~6个月均低于SG组(P<0.05),SG组、RYGB组和SG+TB组的进食量差异无统计学意义(P>0.05)。SG组、RYGB组和SG+TB组术后1~6个月的FBG水平均低于假手术组;术后4~6个月RYGB组和SG+TB组的FBG水平低于SG组(P<0.05)。SG组、RYGB组和SG+TB组术后OGTT和ITT检测的血糖水平均低于假手术组(P<0.05),且均低于术前水平(P<0.05),并且RYGB组在术后第1个月时OGTT检测的血糖水平低于SG组和SG+TB组(P<0.05),而在术后6个月OGTT检测的血糖水平RYGB组和SG+TB组间的差异无统计学意义(P>0.05),但均低于SG组(P<0.05)。SG组、RYGB组和SG+TB组术后UACR、Scr和BUN水平均低于假手术组(P<0.05),且均低于术前(P<0.05);RYGB组和SG+TB组在术后第1和Objective To compare the effectiveness of three kinds of sleeve gastrectomy(SG),Roux-en-Y gastric bypass(RYGB),and sleeve gastrectomy combined with transit bipartition(SG+TB)as three weight-loss surgical differences in weight loss and glucose control as well as alleviation of nephropathy in obese rats with diabetic nephropathy(DN).Methods Twelve of 60 SD male rats were randomly selected according to their average body mass and fed with a standard diet(12%fat fever)as normal control(NC)group,and the remaining 48 were fed with high-fat diet(40%fat calories)for 1 month and combined with low-dose 1%streptozotocin method to induce the establishment of obese combined diabetic nephropathy rat model,and subsequently randomized equally into SG group,RYGB group,SG+TB group and sham-operated group.Body mass and food intake were weighed and the fasting blood glucose(FBG)level after fasting for 6 hours was detected before and every month at 1–6 months after operation.At the same time,oral glucose tolerance test(OGTT),insulin tolerance test(ITT),urinary albumin creatinine ratio(UACR),serum creatinine(Scr)and blood urea nitrogen(BUN)were tested before operation and at the 1st and 6th month after operation.Finally,rat kidney tissues were taken to observe the pathological changes.Results Body mass and food intake of the SG group,the RYGB group and the SG+TB group were lower than that of the sham-operated group at 1–6 months after operation(P<0.05).The body mass of the RYGB group and the ST+TB group were lower than that of the SG group at 1–6 months after operation(P<0.05).There was no significant difference in food intake among the SG group,the RYGB group and the SG+TB group(P>0.05).The FBG levels in the SG group,the RYGB group and the SG+TB group were lower than those in the sham-operation group at 1–6 months after operation(P<0.05).The FBG levels in the RYGB group and the SG+TB group were lower than those in the SG group at 4–6 months after operation(P<0.05).The blood glucose levels detected by OGTT and ITT in the SG

关 键 词：袖状胃切除联合双通路转流术 胃旁路术 袖状胃切除术 糖尿病肾病 减重手术 

分 类 号：R587.2[医药卫生—内分泌] R692.9[医药卫生—内科学]