Laessle Claudia, Michelmichel Sven, Marjanovic Goran, Kuesters Simon, Seifert Gabriel, Hopt Ulrich T, Fink Jodok Matthias
Department of General and Visceral Surgery, Albert-Ludwigs-University, Hugstetter Straße 55, 79106, Freiburg, Germany.
Obes Surg. 2017 Aug;27(8):2090-2098. doi: 10.1007/s11695-017-2611-z.
Metabolic surgery is known to impact glucose tolerance but the exact mechanism is still unclear. Based on recently-published data, especially the role of the hindgut may require redefinition.
Either a loop duodeno-jejunostomy (DJOS) with exclusion of one third of total intestinal length, a loop duodeno-ileostomy (DiOS, exclusion of two thirds), or SHAM operation was performed in 9-week-old Zucker diabetic fatty rats. One, 3, and 6 months after surgery, an oral glucose tolerance test (OGTT) and glucose-stimulated hormone analyses were conducted. Body weight was documented weekly.
DJOS and DiOS animals showed significantly better glucose control in all OGTTs than the SHAM group (two-way ANOVA p < 0.0001). Body weight developed largely parallel in both intervention groups; SHAM animals had gained significantly less weight after 6 months (Mann-Whitney DJOS/DiOS vs. SHAM p < 0.05, DJOS vs. DiOS p > 0.05). Operative interventions had no impact on GLP-1 and GIP levels at any time point (Mann-Whitney p > 0.05 for all). DJOS/DiOS operations could preserve insulin production up to 6 months, while there was already a sharp decline of insulin levels in the SHAM group (Mann-Whitney: DJOS/DiOS vs. SHAM p < 0.05 for all time points). Additionally, insulin sensitivity was improved significantly 1 month postoperative in both intervention groups compared to SHAM (Mann-Whitney DJOS/DiOS vs. SHAM p < 0.05).
The data of the current study demonstrate a sharp amelioration of glucose control after duodenal exclusion with unchanged levels of GLP-1 and GIP. Direct or delayed hindgut stimulation had no impact on glucose control in our model.
代谢手术已知会影响糖耐量，但确切机制仍不清楚。根据最近发表的数据，尤其是后肠的作用可能需要重新定义。
对9周龄的Zucker糖尿病肥胖大鼠进行全肠长度三分之一切除的十二指肠空肠袢式吻合术（DJOS）、全肠长度三分之二切除的十二指肠回肠袢式吻合术（DiOS）或假手术。术后1、3和6个月，进行口服葡萄糖耐量试验（OGTT）和葡萄糖刺激激素分析。每周记录体重。
在所有OGTT中，DJOS和DiOS组动物的血糖控制明显优于假手术组（双向方差分析p<0.0001）。两个干预组的体重增长基本平行；假手术组动物在6个月后体重增加明显较少（Mann-Whitney检验：DJOS/DiOS组与假手术组比较p<0.05，DJOS组与DiOS组比较p>0.05）。手术干预在任何时间点对胰高血糖素样肽-1（GLP-1）和葡萄糖依赖性促胰岛素多肽（GIP）水平均无影响（Mann-Whitney检验，所有p>0.05）。DJOS/DiOS手术可使胰岛素分泌维持6个月，而假手术组胰岛素水平已急剧下降（Mann-Whitney检验：DJOS/DiOS组与假手术组在所有时间点比较p<0.05）。此外，与假手术组相比，两个干预组术后1个月胰岛素敏感性均显著提高（Mann-Whitney检验：DJOS/DiOS组与假手术组比较p<0.05）。
本研究数据表明，十二指肠切除术后血糖控制明显改善，而GLP-1和GIP水平未改变。在我们的模型中，直接或延迟的后肠刺激对血糖控制无影响。
