保留不同胃容量的Rou-en—Y胃旁路术对糖尿病大鼠降糖效果的比较

Comparative effects of Roux-en-Y gastric bypass procedures preserving different gastric volume on blood glucose in Goto-Kakizaki rats

目的观察保留不同胃容量的Roux-en-Y胃旁路术（RYGBP）对糖尿病大鼠降糖效果的比较。方法36只雄性Got0，Kakizaki（GK）大鼠随机分3组，分别为全胃切除RYGBP、胃大部切除RYGBP和保留全胃RYGBP组，每组12只。检测术前及术后1、3、6、12和24周各组大鼠体质量、日均摄食量和空腹血糖水平，测定术前、术后12和24周各组糖化血红蛋白水平及口服葡萄糖后0、30、60、120和180min血糖值，描制血糖值随时间变化曲线，计算糖耐量曲线下面积（AUC）。结果与术前比较．术后1周各组摄食量和体质量显著减少（P〈O．01），术后3周胃大部切除RYGBP组和保留全胃RYGBP组大鼠摄食量及体质量较术后1周明显增加（氏0．01），而全胃切除RYGBP组大鼠摄食量及体质量较其余两组低（P〈O．05）。术后24周。3组大鼠空腹血糖分别为（7．3±1．5）、（7．5±2．0）和（8．3±1_3）mmol／L，均低于术前水平[（13．2±1．6）、（13．6±2．5）和（12．9±2．0）mmol／L，P〈0．01]。而3组间比较，差异无统计学意义（P〉O．05）；糖化血红蛋白则分别为（6-3±1．3）％、（6．4±．2．0）％和（7．0±1．3）％，均低于术前[（10．2±．2．6）％、（9．6±2．5）％和（9．9±2．0）％，P〈0．01]，而3组间比较，差异无统计学意义（P〉O．05）：3组术后糖耐量试验和AUC变化趋势与之类似。结论RYGBP可有效控制血糖水平．其降糖效果与胃容积的大小无明显联系。

Objective To compare the effects of Roux-en-Y gastric bypass （RYGBP） procedures preserving different gastric volume on blood glucose of rats with non-obese type 2 diabetes. Methods A total of 36 Goto-Kakizaki rats randomly underwent one of the following procedures： gastric bypass with different types of anastorrlosis including the Roux-en-Y of total stomach excision （n=12）, the Roux-en-Y of partial stomach excision （n=12） and the Roux-en-Y of stomach preservation （n=12）. Rats were observed for 24 weeks after surgery. Body weight, food intake and fasting blood glucose level were tested at 0 （preoperative）, 1, 3, 6, 12, 24 weeks. Hematoglobin Alc （HbAle） level was measured at 0, 12, 24 weeks and glucose tolerance test （OGTr） was performed in conscious rats before （baseline） and then 30, 60, 120, and 180 minutes. Change of blood glucose over time was depicted. Area under curve （AUC） of glucose tolerance were calculated. Results Compared with preoperative levels, the weight and food intake of all the rats were significantly decreased at 1 week after surgery （P〈0.01）. At 3 weeks after operation, the weight and food intake were significantly increased compared with 1 week after operation in the Roux-en-Y of partial stomach excision and the Roux-en-Y of stomach retention （P〈0.01）. In the Roux-en-Y of total stomach excision, the weight andfood intake were significantly lower compared with other two groups （P〈0.05）. At 24 weeks after operation, the levels of fasting blood glucose were （7.3＋1.5）, （7.5±2.0） and （8.3±1.3） mmol/L, which were lower than the preoperative levels [（13.2±1.6）, （13.6±2.5） and （12.9±2.0） mmol/L, P〈0.01 ] in the three groups. There were no significant differences among the three groups （P〉0.05）. At 24 weeks after operation, the HbAlc levels were （6.3±1.3）%, （6.4±2.0）% and （7.0±1.3）%, which were lower than the preoperative level[ （10.2±2.6）%, （9.6±2.5） and （9.9±2.0）%, P〈0.01 ]. There were no significant differences among the three groups（P〉0.05）. The trend of the glucose tolerance test and AUC were similar in the three groups after operation. Conclusion Roux-en-Y gastric bypass in non- obese diabetic rats is effective in terms of glucose control and the efficacy of gastric bypass has no obvious association with the stomach volume.