胃袖状切除附加改良空回肠旁路术CK大鼠模型的建立与分析

Creation and analysis of the model of sleeve gastrectomy with modified jejunoileal bypass

目的建立胃袖状切除附加改良空回肠旁路的GK大鼠模型并对其分析。方法将GK大鼠随机分为胃袖状切除附加改良空回肠旁路（SG／MJIB）组、假手术（sham-SG／MJIB）组、饮食配对组（PF）组和空白对照（Controls）组。动态观察手术前和手术后体重、进食量、空腹血糖、口服葡萄糖耐量试验（OGTr）、胰岛素浓度及其手术后16周胰岛内组织学的变化。结果自手术后第4周起，SG／MJIB组与sham-SG／MJIB组和PF组间的体重增量差异有统计学意义（P〈0．01）。SG／MJIB组空腹血糖浓度较其它3组明显降低（P〈0，05）。术后第2周SG／MJIB组的OGTr曲线下面积（AUC）较术前减少约38．9％（P〈0．01），较其它3组明显改善（P〈0．01）。在术后实验的整个周期内SG／MJIB组的胰岛素水平明显低于sham-SG／MJIB组（P〈0．05）。手术后第16周，SG／MJIB组胰岛的形态明显改善，胰岛内阳性B细胞的量和成熟腺泡的量明显增加，而在sham-SG／MJIB组却无以上明显变化。结论SG／MJIB独立于体重和进食量的变化直接控制GK大鼠体内血糖水平，为2型糖尿病治疗机制的研究提供了一种稳定、持久的降糖手术模型。

Objective To construct and analyze the model of the sleeve gastrectomy with modified jejunoileal bypass （SG/MJIB） on non-obese Goto - kakizaki （GK） rats. Methods GK rats were randomly divided into SG/MJIB, sham-SG/MJIB, pair fed （PF） and controls group. Before and after surgery, the changes of weight, food intake, fasting glucose, oral glucose tolerance test （OGTT）, insulin tolerance test （ ITF）, fasting plasma Insulin and the histological changes in islet were dynamically observed for 16 weeks. Results From the 4th week postoperative, the weight changes of SG/MJIB significantly decreased compared with sham-SG/MJIB and PF group （ P 〈 0.01 ）. Fasting glucose concentration of SG/MJIB animals was lower than sham-SG/MJIB, PF and controls group （ P 〈 O. 05 ）. The OGTI＇ of SG/MJIB rats was obvi- ously improved compared with the sham-SG/MJIB, PF and controls group （ P 〈 0. 01 ）. Two weeks after operation, glucose tolerance was better improved in SG/MJIB than preoperative, the area under the curve （AUC） of blood glucose concentration decreased by about 38.9% （ P 〈 0. 01 ）. Postoperative insulin lev- els in SG/MJIB group were obviously lower than sham-SG/MJIB group throughout the experiment （ P 〈 0.05）. In the 16th week, the morph of pancreatic islet of SG/MJIB was obviously improved. In the SG/ MJIB group, the number of positive β-cell and mature acinus was significantly increased, while sham surgery groups had no obvious changes as mentioned above. Conclusions SG/MJIB was directly linked to the reduction in glucose levels in GK rats, independently weight loss and caloric intake, and it can be served as a stable long-lasting hypoglycemic surgery model to research the mechanism for the treatment of type 2 dia betes.