Department of General Surgery, Qilu Hospital of Shandong University, Experimental Center, School of Chemistry and Chemical Engineering, Shandong University, Jinan, Shandong 250012, China.
Chin Med J (Engl). 2012 Mar;125(5):912-9.
Bariatric surgery offers successful resolution of type 2 diabetes mellitus (T2DM). However, recurrence of T2DM has been observed in a number of patients with initial resolution after bariatric surgery. This study aimed to induce reversal of the improvement of diabetes in T2DM rats after duodenal-jejunal bypass (DJB), and identify the effects of weight changes and gut hormones that might be involved.
DJB surgery was performed in two T2DM rat models (n=20 for each group): non-obese Goto-Kakizaki (GK) rats, and moderately-obese T2DM rats induced by a combination of a high-fat diet (HFD) and low-dose streptozotocin (HS rats). The controls were sham-operated and non-treated rats. All rats were then randomly divided into HFD- and low-fat diet (LFD)-fed groups. Glucose tolerance, insulin tolerance, glucose-stimulated insulin, glucagon-like peptide-1 (GLP-1) and peptide YY (PYY) secretion, food intake and body weight were measured and compared with controls.
DJB surgery resulted in a significant improvement in glucose tolerance in both GK and HS rats fed with either HFD or LFD. In contrast to LFD-fed rats, improved glucose tolerance was impaired in GK and HS rats fed with an HFD, accompanied by re-impairment of insulin tolerance and failure in enhancement of insulin secretion. There was no significant difference in food intake and body weight between DJB-operated and control rats, and between HFD- and LFD-fed rats. Glucose-stimulated GLP-1 and PYY levels were significantly increased after DJB surgery; however, they were not significantly different between HFD- and LFD-fed rats.
An HFD reverses the improvement in glucose tolerance induced by DJB surgery in T2DM rats, primarily ascribing to the re-impairment of insulin sensitivity, but does not change body weight, GLP-1 and PYY levels.
减重手术可成功解决 2 型糖尿病（T2DM）。然而，在一些患者中，减重手术后 T2DM 最初得到缓解，但后来又复发了。本研究旨在诱导 T2DM 大鼠在接受十二指肠空肠旁路（DJB）手术后糖尿病改善的逆转，并确定可能涉及的体重变化和肠道激素的影响。
在两种 T2DM 大鼠模型（每组 20 只）中进行 DJB 手术：非肥胖 Goto-Kakizaki（GK）大鼠和高脂肪饮食（HFD）和低剂量链脲佐菌素（HS）联合诱导的中度肥胖 T2DM 大鼠。对照组为假手术和未治疗的大鼠。然后，所有大鼠随机分为 HFD 和低脂饮食（LFD）喂养组。测量葡萄糖耐量、胰岛素耐量、葡萄糖刺激胰岛素、胰高血糖素样肽-1（GLP-1）和肽 YY（PYY）分泌、摄食量和体重，并与对照组进行比较。
DJB 手术后，无论是 HFD 还是 LFD 喂养的 GK 和 HS 大鼠，葡萄糖耐量均显著改善。与 LFD 喂养的大鼠不同，HFD 喂养的 GK 和 HS 大鼠的葡萄糖耐量改善受损，同时胰岛素耐量受损，胰岛素分泌增强失败。DJB 手术组和对照组大鼠之间、HFD 和 LFD 喂养组大鼠之间的摄食量和体重无显著差异。DJB 手术后，葡萄糖刺激 GLP-1 和 PYY 水平显著升高；然而，HFD 和 LFD 喂养组大鼠之间没有显著差异。
HFD 逆转了 DJB 手术诱导的 T2DM 大鼠葡萄糖耐量的改善，主要归因于胰岛素敏感性的再次受损，但不改变体重、GLP-1 和 PYY 水平。
