Wang Yu, Zhang Zai-zhong, Wang Lie, Deng Zhi-zhou, Jiao Ya-bin, Zou Zhong-dong
Research Institute of General Surgery, Fuzhou General Hospital of Nanjing Military Area Command, Fuzhou, China.
Zhonghua Yi Xue Za Zhi. 2009 Nov 3;89(40):2858-61.
To evaluate the effect of diabetic control after small intestine exclusion surgery in Goto-Kakizaki (GK) rat with type 2 diabetes mellitus.
GK type 2 diabetic rats underwent duodenal bypass (Group A, n = 8) creating a shortcut for ingested nutrients with bypassing duodenum alone, or duodenal-jejunal bypass (Group B, n = 8), a stomach-preserving RYGB excluding duodenum and proximal jejunum, or duodenum and total jejunum exclusion (Group C, n = 8), or sub-total small intestine exclusion (Group D, n = 8) creating a shortcut for ingested nutrients with bypassing duodenum, jejunum and sub-total ileum. Controls were pair-fed (PF) sham-operated and untreated GK rats (Group SO, n = 8). Rats were observed for 24 weeks after surgery. Fasting blood glucose (FBG) level was determined on a Surestep plus blood glucose meter (Lifescan) at 0, 1, 3, 6, 12, 24 week. Hemoglobin A1c (HbA1c) level was measured at 0, 12, 24 week on VARIANT Hemoglobin A1c Program (Bio-Ray) with high performance liquid chromatography (HPLC) method.
The fasting blood glucose and HbA1c levels significantly decreased after surgery in all the operative groups through the entire follow-up period [Group B (FBG before surgery and 1 week after: (162 +/- 44) mg/dl vs (80 +/- 19) mg/dl; HbAlc before surgery and 12 week after: (8.2 +/- 2.2)% vs (5.1 +/- 1.5)%, P < 0.05 or P < 0.01]; while FBG had no differences before 12 week and significantly increased at 12 week (164 +/- 44) mg/dl and 24 week (180 +/- 42) mg/dl in group SO [preoperative (145 +/- 35) mg/dl, P < 0.01]. As compared with sham-operated rats, all the operative groups showed reduced blood-glucose and HbA1c levels through the entire follow-up period (P < 0.05 or P < 0.01). The FBG and HbA1c levels in Group B significantly decreased versus Group A [24 week (FBG: (82 +/- 21) mg/dl vs (111 +/- 27) mg/dl; HbA1c: (3.9 +/- 0.9)% vs (5.4 +/- 1.2)%, P < 0.05], indicating that duodenal-jejunal bypass had markedly a better effect of diabetic control. But Groups B, C and D were similar to one another (P > 0.05), suggesting that a potential role of proximal gut in the pathogenesis of disease.
In spontaneous type 2 diabetes mellitus rats, all the small intestinal exclusion including proximal gut are effective in glucose control. In terms of intestinal nutrient absorption, duodenal-jejunal bypass may be an ideal surgery for clinical diabetic control. These findings suggest a potential role of proximal intestine in pathogenesis of type 2 diabetes mellitus.
评估小肠旷置手术对2型糖尿病Goto-Kakizaki（GK）大鼠糖尿病控制的效果。
GK 2型糖尿病大鼠接受十二指肠旁路手术（A组，n = 8），仅绕过十二指肠为摄入的营养物质创造一条捷径；或十二指肠-空肠旁路手术（B组，n = 8），即保留胃的Roux-en-Y胃旁路术，排除十二指肠和近端空肠；或十二指肠和全空肠旷置术（C组，n = 8）；或次全小肠旷置术（D组，n = 8），绕过十二指肠、空肠和次全回肠为摄入的营养物质创造一条捷径。对照组为配对喂养（PF）的假手术未治疗GK大鼠（假手术组，n = 8）。术后观察大鼠24周。在0、1、3、6、12、24周时，使用Surestep plus血糖仪（LifeScan）测定空腹血糖（FBG）水平。在0、12、24周时，采用高效液相色谱（HPLC）法在VARIANT血红蛋白A1c检测程序（Bio-Ray）上测定糖化血红蛋白（HbA1c）水平。
在整个随访期间，所有手术组术后空腹血糖和HbA1c水平均显著降低[B组（术前及术后1周FBG：(162±44)mg/dl对(80±19)mg/dl；术前及术后12周HbAlc：(8.2±2.2)%对(5.1±1.5)%，P<0.05或P<0.01）]；而假手术组在12周前FBG无差异，在12周时显著升高至(164±44)mg/dl，24周时为(180±42)mg/dl[术前(145±35)mg/dl，P<0.01]。与假手术大鼠相比，所有手术组在整个随访期间血糖和HbA1c水平均降低（P<0.05或P<0.01）。B组的FBG和HbA1c水平与A组相比显著降低[24周时（FBG：(82±21)mg/dl对(111±27)mg/dl；HbA1c：(3.9±0.9)%对(5.4±1.2)%，P<0.05]，表明十二指肠-空肠旁路术对糖尿病控制效果明显更好。但B、C、D组之间相似（P>0.05），提示近端肠道在疾病发病机制中可能起作用。
在自发性2型糖尿病大鼠中，所有包括近端肠道的小肠旷置术对血糖控制均有效。就肠道营养吸收而言，十二指肠-空肠旁路术可能是临床糖尿病控制的理想手术。这些发现提示近端小肠在2型糖尿病发病机制中可能起作用。
