Department of General Surgery, Fuzhou General Hospital of the PLA, 156 North Xierhuan Road, Fuzhou, 350025, Fujian, China.
Clinical Institute of Fuzhou General Hospital, Fujian Medical University, 156 North Xierhuan Road, Fuzhou, 350025, Fujian, China.
Obes Surg. 2018 Oct;28(10):3087-3094. doi: 10.1007/s11695-018-3291-z.
Several studies have found that metabolic surgery can significantly improve glucose homeostasis; however, the intrinsic mechanisms remain unclear. Accumulating evidence suggests that duodenal bypass plays a crucial role in the treatment of type 2 diabetes mellitus (T2DM). Here, we aimed to evaluate the effect of duodenal reflux on glucose metabolism in T2DM.
A high-fat diet and low-dose streptozotocin (STZ) administration were used to induce T2DM in male rats, which were assigned to three experimental groups: sham operation (SO; n = 10), new duodenal-jejunal bypass (NDJB; n = 10), and new duodenal-jejunal bypass with a tube (NDJBT; n = 10). Weight, food intake, oral glucose tolerance test (OGTT) results, glucagon-like peptide 1 (GLP-1) levels, and histopathology were assessed before or after surgery. Plain abdominal radiography was performed 1 week after the operation.
Plain abdominal radiography indicated the occurrence of contrast agent reflux into the duodenum. The body weight and food intake in all three groups did not significantly differ before and after surgery. The NDJB and particularly the NDJBT groups exhibited better glucose tolerance, lower fasting blood glucose (FBG) levels, lower area under the curves for OGTT (AUC) values, and higher GLP-1 levels, as compared with the sham group postoperatively. The villus height and crypt depth were both shorter in the biliopancreatic limb after NDJBT, as compared with those after SO and NDJB.
Thus, exclusion of the duodenum alone and tube placement can effectively prevent duodenal reflux and improve glucose homeostasis, which further suggests that the duodenum plays an important role in T2DM.
多项研究发现代谢手术可显著改善葡萄糖稳态，但内在机制尚不清楚。越来越多的证据表明十二指肠旁路在治疗 2 型糖尿病（T2DM）中起着至关重要的作用。在这里，我们旨在评估十二指肠反流对 T2DM 葡萄糖代谢的影响。
采用高脂肪饮食和低剂量链脲佐菌素（STZ）注射诱导雄性大鼠发生 T2DM，将其分为三组：假手术（SO）组（n=10）、新十二指肠空肠旁路（NDJB）组（n=10）和新十二指肠空肠旁路加管（NDJBT）组（n=10）。手术前后评估体重、摄食量、口服葡萄糖耐量试验（OGTT）结果、胰高血糖素样肽 1（GLP-1）水平和组织病理学变化。术后 1 周进行腹部平片检查。
腹部平片提示造影剂反流至十二指肠。三组大鼠的体重和摄食量在手术前后均无显著差异。与 SO 组相比，NDJB 组和特别是 NDJBT 组术后葡萄糖耐量更好，空腹血糖（FBG）水平更低，OGTT 曲线下面积（AUC）值更低，GLP-1 水平更高。与 SO 组和 NDJB 组相比，NDJBT 组的胆胰支绒毛高度和隐窝深度均更短。
因此，单独排除十二指肠和放置导管可以有效防止十二指肠反流并改善葡萄糖稳态，这进一步表明十二指肠在 T2DM 中起重要作用。
