Miyachi Tomohiro, Nagao Munenori, Shibata Chikashi, Kitahara Yoshiro, Tanaka Naoki, Watanabe Kazuhiro, Tsuchiya Takahiro, Motoi Fuyuhiko, Naitoh Takeshi, Unno Michiaki
Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Surgery, Tohoku Pharmaceutical University Hospital, Sendai, Japan.
Surgery. 2016 May;159(5):1360-71. doi: 10.1016/j.surg.2015.11.027. Epub 2016 Jan 6.
Roux-en-Y gastric bypass improves glucose metabolism in clinical practice, and duodenal-jejunal bypass (DJB), an experimental bypass procedure, also improves metabolism in animals. However, the mechanism remains controversial; especially, the role of the biliopancreatic limb (BP-limb) remains unclear. Our aim was to examine the importance of the function of the BP-limb after DJB using a novel operative model.
Otsuka Long-Evans Tokushima Fatty rats with diabetes were divided into the following groups: DJB with a short alimentary limb (A-limb) and long BP-limb (B-DJB group), DJB with jejunectomy (J-DJB group) in which the entire length of the jejunum used for the BP-limb of the B-DJB group was excised; and a sham operation group. Glucose tolerance, plasma bile acid levels, and the gut microbiota were assessed postoperatively.
Glucose tolerance was improved and weight gain was suppressed after surgery in the B-DJB group. In contrast, these effects were cancelled in the J-DJB group. The plasma levels of bile acids in the B-DJB group were greater than those in other groups. The analysis of gut microbiota showed distinct differences between the B-DJB and other groups; especially, the relative abundance of genus Bifidobacterium was much higher in the B-DJB group.
The BP-limb played an important role in the control of weight gain, glucose tolerance, and increased plasma bile acid levels after DJB in this rat model of type 2 diabetes mellitus. Plasma bile acids and gut microbiota may be involved in these processes.
在临床实践中，Roux-en-Y胃旁路术可改善葡萄糖代谢，十二指肠-空肠旁路术（DJB）作为一种实验性旁路手术，也可改善动物的代谢。然而，其机制仍存在争议；尤其是胆胰支（BP支）的作用仍不清楚。我们的目的是使用一种新型手术模型来研究DJB术后BP支功能的重要性。
将患有糖尿病的大冢长-埃文斯-德岛肥胖大鼠分为以下几组：短消化道支（A支）和长BP支的DJB组（B-DJB组）、切除B-DJB组用于BP支的整个空肠长度的空肠切除术DJB组（J-DJB组）；以及假手术组。术后评估葡萄糖耐量、血浆胆汁酸水平和肠道微生物群。
B-DJB组术后葡萄糖耐量得到改善，体重增加受到抑制。相比之下，J-DJB组的这些作用消失。B-DJB组的血浆胆汁酸水平高于其他组。肠道微生物群分析显示B-DJB组与其他组之间存在明显差异；尤其是，双歧杆菌属的相对丰度在B-DJB组中要高得多。
在该2型糖尿病大鼠模型中，BP支在DJB术后体重增加的控制、葡萄糖耐量以及血浆胆汁酸水平升高中发挥了重要作用。血浆胆汁酸和肠道微生物群可能参与了这些过程。
