两种外科手术治疗大鼠非肥胖2型糖尿病的疗效对比

目的对比Roux-en-Y胃转流术及胆胰分流术治疗大鼠非肥胖2型糖尿病的疗效。方法 48只雄性Goto-Kakizaki(GK)大鼠随机分为Roux-en-Y胃转流术(Roux-en-Y gastric bypass,RYGBP)、胆胰分流术(billiopancreatic diver-sion,BPD)和假手术组,每组16只。检测术前及术后1、3、6、9、12、24周空腹血糖、胰岛素水平,检测术前及术后6、12、24周糖化血红蛋白,计算胰岛素抵抗指数(HOMA-IR),观察术后各组死亡率和并发症。结果术后1～24周Roux-en-Y胃转流术、胆胰分流术组空腹血糖显著降低(P<0.05,P<0.01),术后12、24周糖化血红蛋白显著降低(P<0.01);假手术组上述指标均未见显著变化。各组空腹胰岛素水平差异无统计学意义。与术前相比,Roux-en-Y胃转流术组和胆胰分流术组术后1～24周HOMA-IR指数显著降低(P<0.05);同时间点两组间比较,术后1～24周胆胰分流术组HOMA-IR指数显著低于Roux-en-Y胃转流术组(P<0.05)。Roux-en-Y胃转流术组死亡率为6%,胆胰分流术组死亡率达50%,胆胰分流术组术后并发症及死亡率均高于Roux-en-Y胃转流术组(P<0.05)。结论 Roux-en-Y和胆胰分流术治疗大鼠非肥胖2型糖尿病疗效相近,但胆胰分流术术后并发症和死亡率高于Roux-en-Y胃转流术。

Efficacy comparison between two kinds of gastric bypass surgery for non-obese type 2 diabetes mellitus in rats

Objective To investigate the effect of diabetes control after different types gastric bypass in an animal model of nonobese type 2 diabetes. Methods 48 Goto-Kakizaki rats randomly underwent one of the following procedures: gastric bypass with different types of Roux-en-Y (n=16), Biliopancreatic diversion(n=16) or sham operation (n=16). At basal time (preoperative) and after intervention (1, 3, 6, 9, 12, 24 week), fasting blood glucose and Hematoglobin A1c (HbA1c) levels were determined. Results Fasting blood glucose levels were significantly decreased as early as 1 week after surgery and then kept a similar level during the entire follow-up period in both Roux-en-Y groups and Biliopancreatic diversion groups(P<0.01 or P<0.05). Compared with basal time, HbA1c levels in both Roux-en-Y and biliopancreatic diversion groups were lower at 12 and 24 weeks after operation (P<0.01). Complication after operation include cacotrophy and diarrhoea, complication of biliopancreatic diversion groups is serious furthest of all, mortality of Roux-en-Y groups and Biliopancreatic diversion is 12% and 50% respectively. Conclusion Our data show that Roux-en-Y groups and Biliopancreatic diversion have the same effective on diabetes control. But Roux-en-Y groups has least complication and mortality after operation.