Grueneberger Jodok Matthias, Fritz Tobias, Zhou Cheng, Meyer Sebastian, Karcz-Socha Iwona, Sawczyn Tomasz, Stygar Dominica, Goos Matthias, Hopt Ulrich Theodor, Küsters Simon
Department of General and Visceral Surgery, Surgical Metabolic and Anastomosis Research Team SMART, Albert-Ludwigs-University, Freiburg, Germany.
Wideochir Inne Tech Maloinwazyjne. 2013 Jun;8(2):130-8. doi: 10.5114/wiitm.2011.32925. Epub 2013 Jan 21.
Fast delivery of food to the terminal ileum is thought to be pathophysiologically responsible for type 2 diabetes remission after obesity surgery. Imitating this effect, ileal transposition (IT) is designed as initiating diabetes remission for non-obese patients.
To date, it is not clear which length of the transposed segment achieves the best glucose lowering results. As previous rodent data mostly rely on a 10 cm IT, the current study evaluated a long segment IT (20 cm) in the diabetic obese Zucker rat.
Twenty male diabetic obese Zucker rats (Crl:ZUC-Lepr(fa)) were randomly assigned to undergo either a long segment (20 cm; ∼ 50% of ileum) IT or sham surgery. Glucose control was determined by an oral glucose tolerance test (OGTT) on day -7, 0, 14 and 20. Analysis of the incretin hormones glucagon-like peptide 1 (GLP-1), peptide YY (PYY) and insulin was included in the first and third OGTT.
Ileal transposition animals showed an early improvement of glucose control after 14 days (area under the curve: IT vs. baseline 314.7 ±229.0 mmol/l × min vs. 564.6 ±268.5 mmol/l × min; p < 0.05). Compared to sham animals, glucose-stimulated GLP-1 and PYY levels were raised (5.75 ±3.73 pmol/l vs. 18.52 ±14.22 pmol/l, p < 0.05; 129.7 ±64.62 pmol/l vs. 164.0 ±62.26 pmol/l, p < 0.05). Body weight gain from postoperative day 5 was greater for sham animals (50.22 ±20.93 γ vs. 16.4 ±25.93 g; p < 0.01).
Long segment IT shows a rapid rise in GLP-1 and PYY levels, thus leading to early amelioration of glucose control.
食物快速输送至回肠末端被认为是肥胖手术后2型糖尿病缓解的病理生理原因。为模拟这种效应，回肠转位术（IT）被设计用于启动非肥胖患者的糖尿病缓解。
迄今为止，尚不清楚转位段的何种长度能实现最佳的降糖效果。由于先前的啮齿动物数据大多基于10厘米的回肠转位术，本研究评估了糖尿病肥胖Zucker大鼠的长段（20厘米）回肠转位术。
将20只雄性糖尿病肥胖Zucker大鼠（Crl:ZUC-Lepr(fa)）随机分为两组，分别接受长段（20厘米；约占回肠的50%）回肠转位术或假手术。在第-7、0、14和20天通过口服葡萄糖耐量试验（OGTT）测定血糖控制情况。在首次和第三次OGTT中对肠促胰岛素激素胰高血糖素样肽1（GLP-1）、肽YY（PYY）和胰岛素进行分析。
回肠转位术组动物在14天后血糖控制情况出现早期改善（曲线下面积：回肠转位术组与基线相比为314.7±229.0毫摩尔/升×分钟，而基线为564.6±268.5毫摩尔/升×分钟；p<0.05）。与假手术组动物相比，葡萄糖刺激的GLP-1和PYY水平升高（5.75±3.73皮摩尔/升对18.52±14.22皮摩尔/升，p<0.05；129.7±64.62皮摩尔/升对164.0±62.26皮摩尔/升，p<0.05）。假手术组动物术后第5天起体重增加更多（50.22±20.93克对16.4±25.93克；p<0.01）。
长段回肠转位术显示GLP-1和PYY水平迅速升高，从而导致血糖控制情况早期改善。
