两种手术方式治疗2型糖尿病机制的研究

Mechanism of Roux-en-Y gastric bypass and gastric banding on type 2 diabetes

目的 比较Roux-en-Y胃旁路术（RYGB）与胃束带术（GB）对链脲佐菌素诱发2型糖尿病（T2DM）大鼠的治疗效果,探讨其机制.方法 40只成模T2DM大鼠分为RYGB组10只;GB组10只;饮食控制组（F组）10只;对照组（C组）10只.检测术前、术后第1、2、3、4、8和16周的空腹血糖、空腹胰岛素样生长因子-1（IGF-1）、空腹血浆瘦素、空腹血浆胰岛素水平、体重及进食量、手术时间、死亡率.结果 GB组术后第16周空腹血糖下降至（12.6±3.7） mmol/L、空腹血浆胰岛素水平升至（58.7±9.2） mU/L、空腹血浆瘦素降至（14.6±3.3） pg/ml、体重（212.6±15.1） g/只,与术前相比差异均有统计学意义（P〈0.01）;RYGB组术后第16周空腹血糖降至（8.6±3.7） mmol/L,血浆IGF-1升至（148.6±7.3） ng/L,空腹血浆胰岛素升至（74.7±9.2） mU/L,空腹血浆瘦素降至（14.1±3.5） pg/ml、空腹体重降至（200±15.1） g/只,与术前相比差异有统计学意义（P〈0.01）;F组与GB组比较,空腹血浆胰岛素和空腹血浆瘦素在术后第3、4周及体重在术后第3周相比均有统计学意义（P〈0.05）,两组手术时间、血糖差异无统计学意义（P〉0.05）.结论 RYGB组较GB组在同时间的空腹血糖和血浆胰岛素改善更明显;血浆胰岛素和血浆瘦素在RYGB组与GB组都起降糖作用.饮食控制及术后血浆胰岛素,空腹血浆瘦素水平改变在GB组发挥重大作用,IGF-1升高可能在Roux-en-Y术后血糖改善中起重要作用.在手术时间上,死亡率GB组优于RYGB组.

Objective To clarify mechanism of Roux-en-Y gastric bypass （RYGB） and gastric banding on diabetes induced by STZ injection. Methods 40 rats with STZ induced diabetes were randomly allocated into Roux-en-Y gastric bypass （RYGB） group （group RYGB, n=10）, gastric banding group （group GB, n=10 ）, diet control group （group F, n=10）, control group （group C,n= 10）. The fasting blood glucose, the fasting insulin IGF-1, the fasting Plasma leptin, the fasting plasma insulin level, the weight and the food-intake, the operation time, the death rate were measured and recored before and after operation on 1st , 2nd, 3 rd ,4th, 8th and 16 th week postoperatively. Results The fasting blood glucose of the group of gastric banding（GB） descended to （12.6±3.7） mmol/L, the fasting plasma insulin rose to （58.7±9.2） mIU/L, the fasting plasma leptin descended to （14.6±3.3） pg/ml, the weight was （212.6±15.1） g.There were significant differences between before and after operation on 16 th week（P〈0.01）. The fasting blood glucose of the group of Roux-en-Y （RYBG） descended to 8.8±4.9 mmol/L in the sixteenth week, the fasting insulin IGF-1 rose to （148.6±7.3） ng/L, the fasting plasma insulin rose to （14.1±3.5） pg/ml, the fasting plasma leptin descended to 14.1±3.5 pg/ml, the weight was （200±15.1） g. There were significant differences between before and after operation 16 th week （P〈0.01）. There were significant differences of the fasting plasma insulin and the the fasting plasma leptin between group F and group C during the 3 rd to 4th week after operation （P〈0.05）. Compared the weight of the group F and the group C on the third week of operation, there were significant differences （P〈0.05）, and there were no significant differences in other time. The fasting blood glucose of the group F and the group C had no sig-nificant differences between before and after operation.（P〈0.05）. Conclusions The fasting blood glucose and the fasting insulin level of the group F improve more than of the group GB at the same time. The plasma insulin and the plasma leptin of the two groups all work in glucose control. The diet control and the modification of the plasma insulin and the plasma leptin all play a major role in the gastric banding mechanism, and the IGF-1 may work in the descending the blood glucose after the operation of Roux-en-Y. In the operation time and die rate, the group of F surpass the group of GB.