van der Burg M P, Gooszen H G, Guicherit O R, Jansen J B, Frölich M, van Haastert F A, Lamers C B
Department of Surgery, University Hospital Leiden, The Netherlands.
Diabetes. 1989 Sep;38(9):1082-9.
Our aim was to isolate and determine the contribution of partial pancreatectomy, systemic delivery of pancreatic hormones, and duct obliteration to glucose regulation after segmental pancreas transplantation in dogs. Fasting, postprandial, and intravenous glucose-stimulated glucose, insulin, glucagon, pancreatic polypeptide (PP), and cholecystokinin (CCK) and intravenous bombesin-stimulated PP levels were studied in beagles at three successive intervals in a crossover design. The first was 6 wk after partial (approximately 70%) pancreatectomy with intact regular enteric exocrine drainage from the duodenal pancreatic remnant, the next was 2 wk after venous transposition with systemic delivery of pancreatic hormones, and the third was 6 wk after in situ duct obliteration of the remnant. With partial pancreatectomy, K values were modestly diminished (30%), and a concomitant reduction of second-phase intravenous glucose-stimulated insulin release was observed. Other parameters were not significantly affected. Venous transposition doubled peripheral plasma levels of insulin under all conditions. Fasting glucose, PP, and CCK levels decreased slightly. Other parameters were not affected. Duct obliteration of the systemic draining pancreatic remnants seriously impaired glucose sensitivity, resulting in a 50% reduction of K values and fasting and sustained postprandial hyperglycemia (approximately 8 mM) and a 70-50% reduction (acute and overall responses, respectively) of intravenous glucose-stimulated insulin. Fasting hormone and postprandial insulin, glucagon, and CCK levels were not affected. The postprandial PP response was severely reduced, and bombesin-stimulated PP release was abolished by duct obliteration. We conclude that histological changes associated with duct obliteration are the major determinants of glucose regulation in segmental pancreas transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
我们的目的是在犬节段性胰腺移植后，分离并确定部分胰腺切除术、胰腺激素的全身递送以及导管闭塞对葡萄糖调节的作用。采用交叉设计，在三个连续时间段对小猎犬的空腹、餐后以及静脉注射葡萄糖刺激后的血糖、胰岛素、胰高血糖素、胰多肽（PP）、胆囊收缩素（CCK）水平，以及静脉注射蛙皮素刺激后的PP水平进行研究。第一个时间段是在部分（约70%）胰腺切除术后6周，十二指肠胰腺残端的肠外分泌引流正常；第二个时间段是在静脉转位术后2周，进行胰腺激素的全身递送；第三个时间段是在残端原位导管闭塞术后6周。部分胰腺切除术后，K值适度降低（30%），同时观察到静脉注射葡萄糖刺激的胰岛素释放的第二阶段有所减少。其他参数未受到显著影响。静脉转位使所有条件下外周血浆胰岛素水平加倍。空腹血糖、PP和CCK水平略有下降。其他参数未受影响。全身引流胰腺残端的导管闭塞严重损害了葡萄糖敏感性，导致K值降低50%，出现空腹和持续餐后高血糖（约8 mM），静脉注射葡萄糖刺激的胰岛素减少70 - 50%（分别为急性和总体反应）。空腹激素以及餐后胰岛素、胰高血糖素和CCK水平未受影响。餐后PP反应严重降低，导管闭塞消除了蛙皮素刺激的PP释放。我们得出结论，与导管闭塞相关的组织学变化是节段性胰腺移植中葡萄糖调节的主要决定因素。（摘要截断于250字）
