• 1.佳木斯大學(xué)第一附屬醫(yī)院普外一科（黑龍江佳木斯154003）;;
  • 2.溫州醫(yī)學(xué)院附屬溫嶺醫(yī)院(浙江溫嶺317500);

目的探討胃轉(zhuǎn)流術(shù)對(duì)糖尿病大鼠空腹血糖的影響及其機(jī)理。方法采用鏈脲佐菌素建立糖尿病SD大鼠模型，隨機(jī)分為糖尿病手術(shù)組（DO組，n=10）和糖尿病對(duì)照組（DC組，n=10），另取20只非糖尿病大鼠隨機(jī)分為正常手術(shù)組（NO組，n=10）和正常對(duì)照組（NC組，n=10）。DO組和NO組大鼠行胃轉(zhuǎn)流術(shù)，DC組和NC組大鼠行假手術(shù)，分別檢測(cè)各組大鼠術(shù)前、術(shù)后72 h和1、4及8周空腹血糖水平以及血清二肽基肽酶-Ⅳ（DPP-Ⅳ）和胰高血糖素樣肽-1（GLP-1）濃度。 結(jié)果術(shù)前DO組與DC組以及NC組與NO組間大鼠空腹血糖差異均無統(tǒng)計(jì)學(xué)意義（P gt;0.05）； DO組大鼠術(shù)后空腹血糖進(jìn)行性下降，至術(shù)后4周達(dá)最低，術(shù)后8周略有上升，均明顯低于術(shù)前（P lt;0.05），DO組大鼠術(shù)后各時(shí)相空腹血糖均明顯高于相應(yīng)時(shí)相的NO組和NC組，但低于DC組（P lt;0.05）； DC組大鼠術(shù)前及術(shù)后各時(shí)相空腹血糖水平的差異均無統(tǒng)計(jì)學(xué)意義（P gt;0.05）； NO組和NC組大鼠組內(nèi)不同時(shí)相以及相同時(shí)相2組間空腹血糖水平差異均無統(tǒng)計(jì)學(xué)意義（P gt;0.05）。 術(shù)前4組大鼠血清DPP-Ⅳ濃度間的差異均無統(tǒng)計(jì)學(xué)意義（P gt;0.05）； 與術(shù)前相比，DO組和NO組大鼠術(shù)后血清DPPⅣ濃度進(jìn)行性下降，且均明顯低于同組術(shù)前結(jié)果（P lt;0.05）； DO組大鼠術(shù)后各時(shí)相血清DPP-Ⅳ濃度均明顯低于相應(yīng)時(shí)相DC組（P lt;0.05），NO組大鼠術(shù)后各時(shí)相血清DPP-Ⅳ濃度也明顯低于相應(yīng)時(shí)相NC組（P lt;0.05）； DC組和NC組大鼠手術(shù)前、后各時(shí)相血清DPP-Ⅳ濃度的差異均無統(tǒng)計(jì)學(xué)意義（P gt;0.05）。 術(shù)前DO組與DC組間以及NO組與NC組間大鼠血清GLP-1濃度的差異均無統(tǒng)計(jì)學(xué)意義（P gt;0.05）； DO組和NO組大鼠術(shù)后血清GLP-1濃度開始明顯升高（P lt;0.05），至術(shù)后4周達(dá)最高，術(shù)后8周稍下降，均明顯高于術(shù)前（P lt;0.05）; DO組大鼠術(shù)后各時(shí)相血清GLP-1濃度均高于相應(yīng)時(shí)相DC組（P lt;0.05），也高于相應(yīng)時(shí)相NO組（除術(shù)后72 h外，均P lt;0.05）； NO組大鼠術(shù)后各時(shí)相血清GLP-1濃度均明顯高于相應(yīng)時(shí)相NC組（P lt;0.05），NO組內(nèi)術(shù)后血清GLP-1濃度無明顯變化（P gt;0.05）； DC組和NC組同組內(nèi)大鼠手術(shù)前、后血清GLP-1濃度無明顯變化（P gt;0.05）。 結(jié)論胃轉(zhuǎn)流術(shù)對(duì)2型糖尿病大鼠具有明顯的降糖作用，DPP-Ⅳ低分泌和GLP-1的升高在其中起著重要作用,胃轉(zhuǎn)流術(shù)但對(duì)正常大鼠血糖無影響。

引用本文： 王躍生,史逸華,陳福軍. 胃轉(zhuǎn)流術(shù)對(duì)2型糖尿病大鼠空腹血糖的影響及其機(jī)理. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(8): 849-853. doi: 復(fù)制

1. Brolin RE. Bariatric surgery and longterm control of morbid obesity [J]. JAMA, 2002, 288(22): 27932796.
2. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it An operation proves to be the most effective therapy for adultonset diabetes mellitus [J]. Ann Surg, 1995, 222(3): 339352.
3. Rubino F, Marescaux J. Effect of duodenaljejunal exclusion in a nonobese animal model of type 2 diabetes: a new perspective for an old disease [J]. Ann Surg, 2004, 239(1): 111.
4. Vetter ML, Cardillo S, Rickels MR, et al. Narrative review: effect of bariatric surgery on type 2 diabetes mellitus [J]. Ann Intern Med, 2009， 150(2): 94103.
5. Wang X, Zhang S, Chen Y, et al. APM1 gene variants 1377C/G and 4545G/C are associated respectively with obesity and with nonobesity in Chinese type 2 diabetes [J]. Diabetes Res Clin Pract, 2009, 84(3): 205210.
6. Patriti A, Facchiano E, Sanna A, et al. The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery [J]. Obes Surg, 2004, 14(6): 840841.
7. Szkudelski J. The mechanism of alloxan and streptozotocin action in B cells of the rat pancreas [J]. Physiol Res, 2001, 50(6): 537546.
8. Koyama M, Wada R, Sakuraba H, et al. Accelerated loss of islet beta cells in sucrosefed GotoKakizaki rats, a genetic model of noninsulindependent diabetes mellitus [J]. Am J Pathol, 1998, 153(2): 537545.
9. Greenway SE, Greenway FL 3rd， Klein S. Effects of obesity surgery on noninsulindependent diabetes mellitus [J]. Arch Surg, 2002, 137(10): 11091117.
10. 戴露倢, 王瑜, 王烈, 等. 胃轉(zhuǎn)流術(shù)對(duì)代謝綜合征改善作用的研究進(jìn)展 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(2): 216219.
11. Ramos AC, Galvo Neto MP, de Souza YM, et al. Laparoscopic duodenaljejunal exclusion in the treatment of type 2 diabetes mellitus in patients with BMI<30 kg/m2 (LBMI) [J]. Obes Surg， 2009, 19(3): 307312.
12. Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion [J]. World J Surg, 1998, 22(9): 936946.
13. Ali MR, Fuller WD, Rasmussen J. Detailed description of early response of metabolic syndrome after laparoscopic RouxenY gastric bypass [J]. Surg Obes Relat Dis, 2009, 5(3): 346351.
14. 鄧治洲, 王烈, 林憶陽, 等. 胃轉(zhuǎn)流術(shù)對(duì)非肥胖型2型糖尿病的療效觀察及其對(duì)胰高血糖樣肽1的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 244(9): 466469.
15. Bose M, Oliván B, Teixeira J, et al. Do Incretins play a role in the remission of type 2 diabetes after gastric bypass surgery: What are the evidence? [J]. Obes Surg, 2009, 19(2): 217229.
16. 張立宏, 王莉莉, 李松. 二肽基肽酶Ⅳ抑制劑藥理學(xué)作用及機(jī)制的研究進(jìn)展 [J]. 中國(guó)新藥雜志, 2009, 18(11): 132134.
17. Degn KB, Juhl CB, Sturis J, et al. One week’s treatment with the longacting glucagonlike peptide 1 derivative liraglutide (NN2211) markedly improves 24 h glycemia and alpha and betacell function and reduces endogenous glucose release in patients with type 2 diabetes [J]. Diabetes, 2004, 53(5): 11871194.
18. Behme MT, Dupré J, McDonald TJ. Glucagonlike peptide 1 improved glycemic control in type 1 diabetes [J]. BMC Endocr Disord, 2003, 3(1): 3.
19. Rao MN, Mulligan K, Tai V, et al. Effects of insulinlike growth factor (IGF)I/IGFbinding protein3 treatment on glucose metabolism and fat distribution in human immunodeficiency virusinfected patients with abdominal obesity and insulin resistance [J]. J Clin Endocrinol Metab, 2010, 95(9): 43614366.
20. Vilsbll T, Zdravkovic M, LeThi T, et al. Liraglutide, a longacting human glucagonlike peptide1 analog, given as monotherapy significantly improves glycemic control and lowers body weight without risk of hypoglycemia in patients with type 2 diabetes [J]. Diabetes Care, 2007, 30(6): 16081610.
21. MacDonald PE, EIKHoly W, Riedel MJ, et al. The multiple actions of GLP1 on the process of glucosestimulated insulin secretion [J]. Diabetes, 2002, 51 Suppl 3: S434S442.
22. Drucker DJ, Nauck MA. The incretin system: glucagonlike peptide1 receptor agonists and dipeptidyl peptidase4 inhibitors in type 2 diabetes [J]. Lancet, 2006, 368(9548): 16961705.
23. Drucker DJ. Dipeptidyl peptidase4 inhibition and the treatment of type 2 diabetes: preclinical biology and mechanisms of action [J]. Diabetes Care, 2007, 30(6): 13351343.
24. Mentlein R. Dipeptidylpeptidase Ⅳ (CD26)—role in the inactivation of regulatory peptides [J]. Regul Pept, 1999, 85(1): 924.
25. Laferrère B, Heshka S, Wang K, et al. Incretin levels and effect are markedly enhanced 1 month after RouxenY gastric bypass surgery in obese patients with type 2 diabetes [J]. Diabetes Care, 2007, 30(7): 17091716.
26. Stearns AT, Balakrishnan A, Tavakkolizadeh A. Impact of RouxenY gastric bypass surgery on rat intestinal glucose transport [J]. Am J Physiol Gastrointest Liver Physiol, 2009, 297(5): G950G957.
27. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and metaanalysis [J]. Am J Med, 2009, 122(3): 248256.
  1. 1. Brolin RE. Bariatric surgery and longterm control of morbid obesity [J]. JAMA, 2002, 288(22): 27932796.
  2. 2. Pories WJ, Swanson MS, MacDonald KG, et al. Who would have thought it An operation proves to be the most effective therapy for adultonset diabetes mellitus [J]. Ann Surg, 1995, 222(3): 339352.
  3. 3. Rubino F, Marescaux J. Effect of duodenaljejunal exclusion in a nonobese animal model of type 2 diabetes: a new perspective for an old disease [J]. Ann Surg, 2004, 239(1): 111.
  4. 4. Vetter ML, Cardillo S, Rickels MR, et al. Narrative review: effect of bariatric surgery on type 2 diabetes mellitus [J]. Ann Intern Med, 2009， 150(2): 94103.
  5. 5. Wang X, Zhang S, Chen Y, et al. APM1 gene variants 1377C/G and 4545G/C are associated respectively with obesity and with nonobesity in Chinese type 2 diabetes [J]. Diabetes Res Clin Pract, 2009, 84(3): 205210.
  6. 6. Patriti A, Facchiano E, Sanna A, et al. The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery [J]. Obes Surg, 2004, 14(6): 840841.
  7. 7. Szkudelski J. The mechanism of alloxan and streptozotocin action in B cells of the rat pancreas [J]. Physiol Res, 2001, 50(6): 537546.
  8. 8. Koyama M, Wada R, Sakuraba H, et al. Accelerated loss of islet beta cells in sucrosefed GotoKakizaki rats, a genetic model of noninsulindependent diabetes mellitus [J]. Am J Pathol, 1998, 153(2): 537545.
  9. 9. Greenway SE, Greenway FL 3rd， Klein S. Effects of obesity surgery on noninsulindependent diabetes mellitus [J]. Arch Surg, 2002, 137(10): 11091117.
  10. 10. 戴露倢, 王瑜, 王烈, 等. 胃轉(zhuǎn)流術(shù)對(duì)代謝綜合征改善作用的研究進(jìn)展 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(2): 216219.
  11. 11. Ramos AC, Galvo Neto MP, de Souza YM, et al. Laparoscopic duodenaljejunal exclusion in the treatment of type 2 diabetes mellitus in patients with BMI<30 kg/m2 (LBMI) [J]. Obes Surg， 2009, 19(3): 307312.
  12. 12. Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion [J]. World J Surg, 1998, 22(9): 936946.
  13. 13. Ali MR, Fuller WD, Rasmussen J. Detailed description of early response of metabolic syndrome after laparoscopic RouxenY gastric bypass [J]. Surg Obes Relat Dis, 2009, 5(3): 346351.
  14. 14. 鄧治洲, 王烈, 林憶陽, 等. 胃轉(zhuǎn)流術(shù)對(duì)非肥胖型2型糖尿病的療效觀察及其對(duì)胰高血糖樣肽1的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 244(9): 466469.
  15. 15. Bose M, Oliván B, Teixeira J, et al. Do Incretins play a role in the remission of type 2 diabetes after gastric bypass surgery: What are the evidence? [J]. Obes Surg, 2009, 19(2): 217229.
  16. 16. 張立宏, 王莉莉, 李松. 二肽基肽酶Ⅳ抑制劑藥理學(xué)作用及機(jī)制的研究進(jìn)展 [J]. 中國(guó)新藥雜志, 2009, 18(11): 132134.
  17. 17. Degn KB, Juhl CB, Sturis J, et al. One week’s treatment with the longacting glucagonlike peptide 1 derivative liraglutide (NN2211) markedly improves 24 h glycemia and alpha and betacell function and reduces endogenous glucose release in patients with type 2 diabetes [J]. Diabetes, 2004, 53(5): 11871194.
  18. 18. Behme MT, Dupré J, McDonald TJ. Glucagonlike peptide 1 improved glycemic control in type 1 diabetes [J]. BMC Endocr Disord, 2003, 3(1): 3.
  19. 19. Rao MN, Mulligan K, Tai V, et al. Effects of insulinlike growth factor (IGF)I/IGFbinding protein3 treatment on glucose metabolism and fat distribution in human immunodeficiency virusinfected patients with abdominal obesity and insulin resistance [J]. J Clin Endocrinol Metab, 2010, 95(9): 43614366.
  20. 20. Vilsbll T, Zdravkovic M, LeThi T, et al. Liraglutide, a longacting human glucagonlike peptide1 analog, given as monotherapy significantly improves glycemic control and lowers body weight without risk of hypoglycemia in patients with type 2 diabetes [J]. Diabetes Care, 2007, 30(6): 16081610.
  21. 21. MacDonald PE, EIKHoly W, Riedel MJ, et al. The multiple actions of GLP1 on the process of glucosestimulated insulin secretion [J]. Diabetes, 2002, 51 Suppl 3: S434S442.
  22. 22. Drucker DJ, Nauck MA. The incretin system: glucagonlike peptide1 receptor agonists and dipeptidyl peptidase4 inhibitors in type 2 diabetes [J]. Lancet, 2006, 368(9548): 16961705.
  23. 23. Drucker DJ. Dipeptidyl peptidase4 inhibition and the treatment of type 2 diabetes: preclinical biology and mechanisms of action [J]. Diabetes Care, 2007, 30(6): 13351343.
  24. 24. Mentlein R. Dipeptidylpeptidase Ⅳ (CD26)—role in the inactivation of regulatory peptides [J]. Regul Pept, 1999, 85(1): 924.
  25. 25. Laferrère B, Heshka S, Wang K, et al. Incretin levels and effect are markedly enhanced 1 month after RouxenY gastric bypass surgery in obese patients with type 2 diabetes [J]. Diabetes Care, 2007, 30(7): 17091716.
  26. 26. Stearns AT, Balakrishnan A, Tavakkolizadeh A. Impact of RouxenY gastric bypass surgery on rat intestinal glucose transport [J]. Am J Physiol Gastrointest Liver Physiol, 2009, 297(5): G950G957.
  27. 27. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and metaanalysis [J]. Am J Med, 2009, 122(3): 248256.