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 Command, Fuzhou 350025, China.
Zhonghua Wai Ke Za Zhi. 2009 Nov 15;47(22):1736-40.
To evaluate the effect and possible mechanisms of diabetes control after small intestine exclusion surgery in Goto-Kakizaki (GK) rat with non-obese type 2 diabetes mellitus.
Forty GK rats with non-obese type 2 diabetes mellitus underwent duodenal bypass (Group A, n = 8), which creates a shortcut for ingested nutrients bypassing duodenum alone; duodenal-jejunal bypass (Group B, n = 8), a stomach-preserving RYGB that excludes the duodenum and proximal jejunum; duodenum and total jejunum exclusion (Group C, n = 8); sub-total small intestine exclusion (Group D, n = 8), which creates a shortcut for ingested nutrients bypassing duodenum, jejunum and sub-total ileum; controls were pair-fed (PF) sham-operated and untreated GK rats (Group SO, n = 8). The rats were observed for 24 weeks after surgery. Body weight, food intake and fasting blood glucose level were tested at 0, 1, 3, 6, 12, 24 weeks after the operation in those groups. The concentrations of insulin and glucagon-like peptide-1 (GLP-1) concentrations were measured before (baseline) and then 30, 60, 120, and 180 minutes after OGTT at 0, 12, 24 weeks after the operation.
Mean operating time of all groups was similar. The mean body weight and food intake decreased significantly at 1 week after surgery (P < 0.01) and with no differences among the groups. Fasting blood glucose level decreased significantly after surgery in all the operation groups through the entire follow-up period (P < 0.05). No significant changes in fasting blood glucose level in SO group was found in 12 weeks after the operation, and it increased at 12 and 24 weeks after. Fasting blood glucose levels in group B decreased significantly compared with group A (P < 0.05), but no difference was found among group B, C and D (P > 0.05). Oral glucose-stimulated peak (30 min) levels of blood insulin and GLP-1 increased markedly in operation groups (A, B, C and D) after surgery (P < 0.01). Compared with group A, peak levels of blood insulin and GLP-1 in group B were strikingly higher (P < 0.05), but no difference was found when compared with group C or D (P > 0.05).
In spontaneously non-obese type 2 diabetes mellitus rats, small intestinal exclusion including proximal gut is effective in terms of glucose control and has no direct relation with body weight and food intake loss. Restoration of the first-phase insulin secretion and high secretion of GLP-1 in type 2 diabetic subjects after gastrointestinal bypass surgery seem to be helpful to diabetes control. Taking intestinal nutrient absorption into consideration, duodenal-jejunal bypass may be a better surgery for diabetes control.
评估小肠旷置手术对非肥胖型2型糖尿病Goto-Kakizaki（GK）大鼠糖尿病控制的效果及可能机制。
40只非肥胖型2型糖尿病GK大鼠接受十二指肠旁路手术（A组，n = 8），该手术为摄入的营养物质单独绕过十二指肠创造一条捷径；十二指肠-空肠旁路手术（B组，n = 8），一种保留胃的Roux-en-Y胃旁路手术，排除十二指肠和空肠近端；十二指肠和全空肠旷置（C组，n = 8）；次全小肠旷置（D组，n = 8），该手术为摄入的营养物质绕过十二指肠、空肠和次全回肠创造一条捷径；对照组为配对喂养（PF）的假手术且未治疗的GK大鼠（SO组，n = 8）。术后观察大鼠24周。在术后0、1、3、6、12、24周检测这些组大鼠的体重、食物摄入量和空腹血糖水平。在术后0、12、24周，于口服葡萄糖耐量试验（OGTT）前（基线）及之后30、60、120和180分钟测量胰岛素和胰高血糖素样肽-1（GLP-1）浓度。
所有组的平均手术时间相似。术后1周平均体重和食物摄入量显著下降（P < 0.01），且组间无差异。在整个随访期内，所有手术组术后空腹血糖水平均显著下降（P < 0.05）。SO组术后12周空腹血糖水平无显著变化，术后12周和24周血糖水平升高。B组空腹血糖水平与A组相比显著下降（P < 0.05），但B、C和D组之间无差异（P > 0.05）。术后手术组（A、B、C和D组）口服葡萄糖刺激的胰岛素和GLP-1血峰值（30分钟）水平显著升高（P < 0.01）。与A组相比，B组胰岛素和GLP-1血峰值水平显著更高（P < 0.05），但与C组或D组相比无差异（P > 0.05）。
在自发性非肥胖型2型糖尿病大鼠中，包括近端肠道的小肠旷置在葡萄糖控制方面有效，且与体重和食物摄入量减少无直接关系。胃肠道旁路手术后2型糖尿病患者一期胰岛素分泌的恢复和GLP-1的高分泌似乎有助于糖尿病控制。考虑到肠道营养吸收，十二指肠-空肠旁路手术可能是更好的糖尿病控制手术。
