保留不同长度十二指肠的DJB术后GK大鼠肠道激素的研究

目的 建立保留不同长度十二指肠十二指肠-空肠转流术（DJB）手术动物模型,探讨术后GK大鼠肠道激素的变化规律.方法 雄性GK大鼠24只随机分为4组（n=6）,Ⅰ组：假手术组;Ⅱ组：DJB手术组;Ⅲ组：十二指肠保留8mmDJB手术组;Ⅳ组：十二指肠保留18mmDJB手术组.分别于DJB术后9周进行颈动脉置管术,置管后1周行口服糖耐量试验及采血检测肠道激素GLP-1及GIP的变化情况.结果 所有大鼠都能长期存活;Ⅲ组GK大鼠的糖耐量、第一时相胰岛素分泌量及GLP-1的分泌量均较Ⅰ组有显著提高（P＜0.05）,GIP初始分泌量较Ⅰ组有显著降低（P＜0.05）; Ⅳ组GK大鼠的糖耐量、第一时相胰岛素及GLP-1的分泌量、GIP初始分泌量较Ⅰ组无明显差异（P＞0.05）; Ⅱ组GK大鼠的第一时相胰岛素及GLP-1的分泌量显著高于Ⅳ组（P＜0.05）,在30 min时GIP分泌量显著高于Ⅳ组（P＜0.05）.结论 胃肠转流手术控制血糖的水平一方面是通过重新建立抑胰岛素分泌激素及促胰岛素分泌激素新的分泌量平衡;另一方面则是通过降低GIP的分泌量,使机体的胰岛素抵抗情况得以改善.

Study on Gut Hormones in GK Rats after Different Length Duodenum-Preserving Duodenal-Jejunal Bypass Surgery

Objective To establish the different length duodenum-preserving duodenal-jejunal bypass model in GK rats and explore the changes in gut hormones after surgery.Methods Male Goto-kakizaki diabetic rats（GK,n=24） were randomly divided into four groups：group Ⅰ （sham group）,group Ⅱ（regular DJB surgery）,group Ⅲ （8mm duodenum-preserving DJB surgery）,group Ⅳ（18mm duodenumpreserving DJB surgery）.Carotid artery intubation was performed ninth week after surgery.OGTF was performed one week after carotid artery intubation.The change of the level of the serum index （blood glucose,insulin,GLP-1,GIP） during OGTT was measured.Results All GK rats after surgery were with a long-term survival.The OGTT,first-phase insulin and GLP-1 secretion in group Ⅲ were improved significantly compared with group Ⅰ （P＜0.05） and the initial secretion of GIP in group Ⅲ was significantly fewer than group Ⅰ （P＜0.05）.The OGTT,first-phase insulin and GLP-1 secretion,the initial secretion of GIP in group Ⅳ had no significant difference compared with group Ⅰ （P＞0.05）.The first-phase insulin and GLP-1 secretion in group Ⅱ were significantly higher than group Ⅳ （P＜0.05） and the GIP secretion at 30 min was significantly higher than group Ⅳ （P＜0.05）.Conclusions On the basis of experimental results,the mechanisms of DJB surgery improving blood glucose level in GK rat might be closely related to the restoration of balance between anti-incretin factors and incretin factors.On the other hand,DJB surgery can improve insulin-resistance in GK rat through reducing the secretion of GIP.