胃旁路术与胆胰转流术治疗2型糖尿病机制的研究

目的 比较胃旁路术(GBP)与胆胰转流术(BPD)对非胰岛素依赖性糖尿病大鼠的治疗效果,探讨其机制.方法 40只糖尿病GK大鼠按数字表法随机分为GBP组、BPD组、饮食控制组和对照组,每组10只.GBP组、BPD组分别行GBP及BPD手术；饮食控制组大鼠每天给予基础饲料15 g,自由进水；对照组不限食量.记录手术时间、死亡率.每周测空腹体重.检测治疗前及治疗后1、2、3、4、8、16周的空腹血糖、瘦素、胰岛素样生长因子-1(IGF-1)水平.结果 GBP组平均手术时间为(25±4)min,BPD组为(35±6)min；GBP组大鼠死亡1只,BPD组死亡3只,两组差异均有统计学意义(P值均＜0.01).治疗前各组大鼠血糖、瘦素及IGF-1水平无统计学差异.治疗后对照组大鼠血糖及瘦素均无明显变化.饮食控制组大鼠治疗后2周起血糖及瘦素水平开始下降,第4周时显著降低,并持续至16周(P＜0.05),但血IGF-1水平无明显变化.GBP组与BPD组大鼠治疗后2周起血糖及瘦素水平开始下降,而血IGF-1水平开始升高,并持续至16周[血糖:(6.8±1.0)、(6.3±0.8)mmol/L比(13.9±2.6)、(14.1±2.4)mmol/L;瘦素:(16.1±3.3)、(17.2±3.2)pg/ml比(29.4±3.9)、(29.4±3.9) pg/ml；IGF-1:( 166.1±8.3)、(142.2±8.2) ng/L比(119.4±8.8)、(109.8±7.9)ng/L,P值均＜0.01],但这两组的血糖及瘦素水平无统计学差异；而GBP组大鼠血IGF-1水平较BPD组升高更显著(P＜0.05).结论 GBP和BPD均能较好地控制糖尿病大鼠的血糖水平,其机制可能与瘦素的降低及IGF-1的升高有关.GBP在手术时间、死亡率及增加血IGF-1水平等方面优于BPD.

Gastric bypass and biliopancrtic diversion in the treatment type 2 diabetes

Objective To compare the treatment effects of gastric bypass (GBP) and biliopancrtic diversion (BPD) in non-insulin dependent diabetes mellitus rats,and investigate the mechanism.Methods Forty GK rats with diabetes mellitus were randomly allocated into four groups:GBP group; BPD group; food restriction group ( FR group) and control group with 10 rats in each group.Rats in GBP group and BPD group received GBP and BPD procedures respectively.Rats in FR group were fed with basic feed of 15 g and free access to water.There was no food restriction in rats in control group.The operation time,mortality was recorded.The fasting body weight was measured every week.The plasma glucose,insulin-like growth factor-1 (IGF-1),and leptin concentrations,were measured before treatment and 1,2,3,4,8,16 week after treatment.Results The mean operation time was (25 ± 4) min in GBP group and (35 ± 6) min in BPD group; one rat died in GBP group and 3 rats died in BPD group,and the difference between the two groups was statistically significant (P ＜ 0.01 ).The levels of plasma glucose,IGF-1 and leptin were not statistically significant among these groups before treatment.There was no significant difference in plasma glucose and leptin concentrations in the control group.The levels of plasma glucose and leptin in rats in FR group began to decrease 2 weeks later,at the 4th week,the levels of plasma glucose and leptin was significantly lower than that before treatment,and it lasted for the 16 th week,but the level of IGF-1 were significantly different.The levels of plasma glucose and leptin in rats in GBP group and BPD group began to decrease and IGF-1 began to increase 2 weeks after operation,and it lasted for the 16th week,[plasma glucose:(6.8 ± 1.0),(6.3 ± 0.8 ) mmol/L vs.(13.9±2.6),(14.1 ±2.6)mmol/L; leptin:(16.1±3.3),(17.2±3.2)pg/ml vs.(29.4±3.9)pg/ml,(29.4±3.9); IGF-1:(166.1±8.3),(142.2±8.2)ng/L vs.(119.4±8.8),(109.8±7.9)ng/L,P＜0.01],but the levels of plasma glucose and leptin was not statistically different between the two groups.The level of IGF-1 in GBP group was significantly higher than that in BPD group (P ＜ 0.05).Conclusions Both GBP and BPD can effectively control plasma glucose concentration for rats with diabetes.The possible mechanism is related to decreased leptin and increased IGF-1.Group GBP had a better outcome in operation time,mortality and increasing IGF-1 than those in group BPD.