摘要
目的观察残胃容积固定下,旷置不同长度小肠的Roux-en-Y胃旁路术（RYGBP）对自发性糖尿病（GK）大鼠糖代谢的影响。方法 50只GK大鼠随机分入假手术组、旷置十二指肠组（旷置组）、旷置十二指肠＋近端1/5空肠组（旷置＋近端1/5空肠组）、旷置十二指肠＋近端1/3空肠组（旷置＋1/3空肠组）、旷置十二指肠＋近端1/2空肠组（旷置＋近端1/2空肠组）共5组,每组10只。检测各组大鼠术前和术后第1、2、4、8、12周的体重、空腹血糖（FPG）、口服葡萄糖耐量实验（OGTT）峰值、糖化血红蛋白（HbA1c）,以及血清胰岛素（INS）、胰高血糖素样肽（GLP）-1。结果旷置＋近端1/5空肠组和旷置＋近端1/3空肠组术后1、8、12周,以及旷置＋近端1/2空肠组术后1、2、4、8、12周的大鼠体重均显著低于假手术组同时间点（P值分别〈0.05、0.01）;旷置＋近端1/2空肠组术后12周的大鼠体重显著低于旷置＋近端1/5空肠组同时间点（P〈0.05）。旷置＋近端1/5空肠组、旷置＋近端1/3空肠组、旷置＋近端1/2空肠组术后1、2、4、8、12周,以及旷置组术后2、4、8、12周的FPG水平均显著低于假手术组同时间点（P值分别〈0.05、0.01）,旷置＋近端1/3空肠组术后4、8、12周和旷置＋近端1/2空肠组术后2、4、8、12周大鼠的FPG水平均显著低于旷置＋近端1/5空肠组同时间点（P值均〈0.05）。旷置＋近端1/5空肠组、旷置＋近端1/3空肠组、旷置＋近端1/2空肠组术后1、8、12周的OGTT峰值均显著低于假手术组同时间点（P值分别〈0.05、0.01）,旷置＋近端1/3空肠组和旷置＋近端1/2空肠组术后8、12周的OGTT峰值均显著低于旷置＋近端1/5空肠组同时间点（P值均〈0.05）。旷置组、旷置＋近端1/5空肠组、旷置＋近端1/3空肠组和旷置＋近端1/2空肠组术后8、12周的HbA1c水平均显著低于假手术组同时间点（P值分别〈0.05、0.01）,旷置＋近端1/3空肠组和旷置＋近端1/2空肠组术后8、12周的空腹HbA1c水平均显著低于旷置＋近端1/5空肠组同时间点（P值均〈0.05）。旷置＋近端1/5空肠组、旷置＋近端1/3空肠组、旷置＋近端1/2空肠组大鼠术后8、12周,以及旷置组术后12周的血清INS和GLP-1水平均显著高于假手术组同时间点（P值分别〈0.05、0.01）;旷置＋近端1/3空肠组术后8周的血清INS和GLP-1水平均显著高于旷置＋近端1/5空肠组同时间点（P值均〈0.05）,旷置＋近端1/2空肠组术后12周的血清INS水平显著高于旷置＋近端1/5空肠组同时间点（P〈0.05）,旷置＋近端1/2空肠组术后8、12周的GLP-1水平均显著高于旷置＋近端1/5空肠组同时间点（P值均〈0.05）。结论 RYGBP对GK大鼠具有确切的改善糖代谢的作用,且与体重变化无关。小肠转流部位以空肠近端1/3~1/2为宜,既可充分保证手术的降糖效果,又可最大限度地减少营养不良的发生。
Objective To explore glucose metabolism in Goto-Kakizkai （GK） rats after Roux-en-Y gastric bypass surgery with fixed residual stomach volume. Methods Fifty GK rats were randomly divided into 5 groups （n = 10）; sham-operation group, duodenal exclusion group, duodenal and proximal 1/5 jejunum exclusion group, duodenal and proximal 1/3 jejunum exclusion group, and duodenal and proximal 1/2 jejunum exclusion group. Preoperative body weight, fasting plasma glucose, oral glucose tolerance test, glycosylated hemoglobin （HbA1 c）, serum insulin and glucagon-like peptide-1 were compared with those on 1, 2, 4, 8, and 12 weeks after operation. Results Compared with sham-operation group, the body weight of rats in the duodenal and proximal 1/5 jejunum exclusion group and duodenal and proximal 1/3 jejunum exclusion group at 1, 8, and 12 weeks after surgery, and the body weight of rats in duodenal and proximal 1/2 jejunum exclusion group at 1, 2, 4, 8, and 12 weeks postoperatively were significantly reduced （P〈0.05 or 0.01）. Twelve weeks after surgery, the body weights of rats in duodenal and proximal 1/2 jejunum exclusion groups were significantly lower than those in duodenal and proximal 1/5 jejunum exclusion groups （P〈O. 05）. The fasting plasma glucose level in duodenal and proximal 1/5, 1/3 and 1/2 jejunum exclusion groups at 1, 2, 4, 8 and 12 weeks after surgery and in duodenal exclusion group at 2, 4, 8 and 12 weeks postoperatively were significantly lower than that in sham-operation group （P〈 0.05 or 0.01 ）. The fasting plasma glucose level in duodenal and proximal 1/3 jejunum exclusion groups at 4, 8 and 12 weeks postoperatively and in duodenal and proximal 1/2 jejunum exclusion group at 2, 4, 8 and 12 weeks postoperatively were significantly lower than those in duodenal and proximal 1/5 jejunum exclusion group （all P〈 0.05）. The oral glucose tolerance test levels in duodenal and proximal 1/5, 1/3 and 1/2 jejunum exclusion groups at 1, 8 and 12 weeks after surgery were significantly lower than those in sham-operation group （P〈0.05 or 0.01 ）. The oral glucose tolerance test levels in duodenal and proximal 1/3 and 1/2 jejunum exclusion groups were significantly lower than those in duodenal and proximal 1/5 jejunum exclusion group at 8 and 12 weeks postoperatively （all P〈O. 05）. The HbA1 c levels in the four duodenal exclusion groups at 8 and 12 weeks after surgery were significantly lower than those in sham-operation group （P〈 0.05 or 0.01 ）. The HbA~ c levels in duodenal and proximal 1/3 and 1/2 jejunum exclusion groups were significantly lower than those in duodenal and proximal 1/5 jejunum exclusion group at 8 and 12 weeks postoperatively （all P〈O. 05）. The serum levels of insulin and glucagon-like peptide-1 in duodenal and proximal 1/5, 1/3 and 1/2 jejunum exclusion groups at 8 and 12 weeks after surgery and in duodenal exclusion group at 12 weeks after surgery were significantly higher than those in sham-operation group （P〈O. 05 or 0.01 ）. The levels of serum insulin and glucagon-like peptide-1 in duodenal and proximal 1/3 jejunum exclusion group were significantly higher than those in duodenal and proximal 1/5 jejunum exclusion group at 8 weeks after surgery （both P〈O. 05）. The serum insulin levels in duodenal and proximal 1/2 jejunum exclusion groups were significantly higher than that in duodenal and proximal 1/5 jejunum exclusion group at 12 weeks after surgery （both P〈O. 05）. The levels of serum glucagon-like peptide-1 in duodenal and proximal 1/2 jejunum exclusion groups were significantly higher than those in duodenal and proximal 1/5 jejunum exclusion group at 8 and 12 weeks after surgery （both P〈O. 05）. Conclusion Roux-en-Y gastric bypass surgery can effectively improve glucose metabolism in GK rats, and the efficacy of gastric bypass has no association with the body weight of rats. In terms of glucose control and nutrient absorption, the duodenal and the proximal 1/3- 1/2 jejunum exclusion may be an ideal surgery for clinical diabetic controJ. （Shanghai Med J, 2014, 37： 325-330）
出处
《上海医学》
CAS
CSCD
北大核心
2014年第4期325-330,共6页
Shanghai Medical Journal
