RYGBP与BPD对2型糖尿病大鼠的血糖控制及GLP-1表达的影响

目的评估Roux-en-Y胃旁路术（Roux-en-Y gastric bypass,RYGBP）与胆胰分流术（billiopancreatic diver-sion,BPD）对2型糖尿病（type 2diabetes mellitus,T2DM）大鼠的临床疗效。探讨胰升糖素样多肽1（glucagon-like pep-tide 1,GLP-1）在手术治疗T2DM中的机制。方法将36只雄性正常体质量Goto-Kakizaki（GK）大鼠随机分为RYG-BP,BPD与假手术组,每组12只。观测分析非肥胖T2DM大鼠术前及术后1周、2周、1个月、2个月、3个月的体质量、空腹血糖（fasting blood glucose,FBG）、血清胰岛素（insulin,INS）水平、糖化血红蛋白（glycosylated hemoglobin A1c,HbA1c）水平、GLP-1水平的变化。观察术后3个月T2DM大鼠的并发症及死亡率的发生情况,寻找最佳手术方式。结果与术前比较,术后1周～3个月RYGBP与BPD组GK大鼠FBG显著降低（P〈0.05）,空腹GLP-1明显升高（P〈0.05）,术后3个月HbA1c显著降低（P〈0.05）,术后3月空腹胰岛素水平显著升高（P〈0.05）。假手术组上述指标均未见明显变化。BPD组GK大鼠死亡率与并发症发生率均较RYGBP组高。结论RYGBP较BPD对非肥胖T2DM具有更安全有效的治疗作用。RYGBP控制血糖可能与GLP-1升高促进胰岛素释放,改善β细胞功能有关。

Effect of RYGBP and BPD on Blood Glucose Control and GLP-1 Expression in Rats with Type 2 Diabetes Mellitus

Objective To observe the clinical efficacy of Roux-en Y gastric bypass （RYGBP） and billiopancreatic diversion （BPD） in the treatment of type 2 diabetes mellitus （T2DM） rats and investigate the change of glucagon-like pep- tide1 （GLP 1） expression in Goto-Kakizaki （GK） rats after surgery. Methods A total of 36 males GK rats were ran- domly divided into three groups： Roux-en-Y gastric bypass group （n = 12）, billiopancreatic diversion group （n = 12）, and sham operation group （n = 12）. The body weight, fasting blood glucose （FBG）, fasting insulin （INS）, glycosylated he- moglobin （HbA1 c） levels and GLP I levels of the rats were determined before operation and 1 week, 2 weeks, 1 month, 2 months and 3 months after operation. The mortality and complication were observed. Results FBG levels were signifi- cantly decreased in 1 week - 3 months after operation in both RYGBP and BPD groups （P〈0. 05）. GLP-1 expressions were significantly increased after operation （P〈0. 05）. HbA1 c levels were decreased in 3 months after operation （P〈0. 05）. The fasting INS levels were significantly increased in 3 months after operation （P〈0. 05）. The above parameters didn＇t change in the sham operation group. The mortality and complication incidence in the BPD group were significantly higher than those in the RYGBP group. Conclusion RYGBP is more effective and safer in treating non-obese T2DM than BPD. The increase of GLP1 may help to advance β-cell function and increase insulin secretion.