摘要
目的：研究胃转流术能长期控制病态肥胖症患者伴发的2型糖尿病的可能机制。方法：将8周龄的Goto-Kakizaki大鼠分为保留胃容量的胃空肠转流组(GJB组)、空回肠短路组(JIB组)、饮食控制组及对照组,术后观察36周,在设定的多个时间点测定空腹血糖、空腹胰岛素、口服葡萄糖耐量实验(OGTT)、胰岛素耐受实验(ITT)。结果：GJB、JIB2组大鼠进食量与体重变化相近,GJB术前空腹血糖为14．2±2．9mmol/L,术后4周为7．0±0．7mmol/L(P＜0．001),并始终保持较低水平。JIB组术前空腹血糖为13．9±2．5mmol/L．术后4周仍高达13．8±2．6mmol/L且长期维持高水平。GJB组OGTT的血糖AUC较术前减少35%(P＜0．001),JIB组无明显改变。前者ITT的血糖AUC减少47%。饮食控制组减重明显,空腹血糖亦有下降,为7．7±1．4mmol/L,但OGTT和ITT未能得到明显改善。结论：在进食量和体重无明显改变的情况下,GJB仍能较好的控制血糖,提示胃转流术能直接地控制2型糖尿病,十二指肠和上端空肠在2型糖尿病的发病原理和治疗中可能起重要的作用。
Objective：The gastric bypass can effectively induces weight loss and long-term control of type 2 diabetes in morbidly obese individuals. The aim of this study was to investigate whether the control of diabetes is a direct result of the duodenaljejunal exclusion. Methods：A Gastrojejunal bypass （GJB） with preservation of an intact gastric volume was performed in 8- week-old Goto-Kakizaki rats. It was challenged against a Jejuno-ileal bypass （JIB）, a food restriction and a control group in matched groups of animals. Fasting glycemia, basal plasma insulin, OGTT, ITT and basal plasma insulin were measured. Rats were observed for 36 weeks after surgery. Results： Mean plasma glucose after GJB was 7. 0 ± 0.7 mmol/L （preoperative values were 14. 2 ± 2.9 mmol/L, P〈0. 001）. Preoperative plasma glucose of JIB was 13. 9 ± 2. 5 mmol/L and no significant difference after operation （13.8 ± 2. 6 mmol/L）. GJB strikingly improved glucose tolerance, inducing a greater than 35% reduction of the area under blood glucose concentration curve （P〈0. 001）. In ITT, the area under blood glucose concentration curve decreased by 47% after operation. These effects were not seen in JIB despite similar operative time, same postoperative food intake rates, and no significant difference in weight gain profile. Although greater weight loss and plasma glucose reduction （7.7 ± 1.4 mmol/L）, food restriction didn＇t improve glucose tolerance and insulin sensitivity according OGTT and ITT. Conclusion：Results of our study support the hypothesis that the gastric bypass can directly control type 2 diabetes as GJB resuited in better glycemic control, with no significant difference in postoperative food intake and weight gain. These findings suggest a potential role of the proximal gut in the pathogenesis of type 2 diabetes and put forth the possibility of alternative therapeutic approaches for the management of this disease.
出处
《中国临床医学》
北大核心
2006年第6期960-962,共3页
Chinese Journal of Clinical Medicine
基金
上海市金山区科学技术委员会科技创新基金项目(NO.2006-3-03)
