胃袖状切除联合空回肠侧侧吻合术对2型糖尿病大鼠减重与改善代谢的影响

Effects of sleeve gastrectomy plus side-to-side jejunoileal anastomosis on weight loss and metabolic control of the rats with type 2 diabetes mellitus

目的 探讨胃袖状切除联合空回肠侧侧吻合术（JI-SG）对2型糖尿病大鼠减重及改善代谢的影响.方法 30只7周龄雄性ZDF大鼠按随机数字表法分为3组,每组10只,分别为JI-SG组、胃袖状切除术（SG）组、对照组.JI-SG组行JI-SG;SG组行单纯SG;对照组行假手术.测定各组大鼠术前1d及术后1、2、4、6、8、10、12周体质量和空腹血糖.于术前1d、术后6周及12周,测定空腹血浆胰岛素、胃饥饿素、胰高血糖素样肽-1（GLP-1）.正态分布的计量资料采用-x±s表示,组间比较采用LSD-t检验,多组间比较采用方差分析,重复测量数据比较采用重复测量方差分析.结果 JI-SG组、SG组、对照组大鼠体质量分别由术前（297.2 ±2.1）g、（302.0±1.8）g、（296.0±2.1）g变化为术后12周的（242.7±13.2）g、（380.4±16.5）g、（440.1±15.1）g,JI-SG组保持平稳,SG组和对照组呈上升趋势,3组比较,差异有统计学意义（F =42.5,P ＜0.05）.JI-SG组、SG组、对照组大鼠术前空腹血糖分别为（11.7±1.7） mmol/L、（11.4 ±3.1）mmol/L、（12.4±1.5） mmol/L,3组比较,差异无统计学意义（F=18.2,P＞0.05）.JI-SG组、SG组、对照组大鼠空腹血糖由术后1周的（5.7±0.7）mmol/L、（6.2±1.6） mmol/L、（7.4±0.5） mmol/L变化为术后12周的（6.9±2.5） mmol/L、（13.9±2.8）mmol/L、（22.2±2.9）mmol/L.与对照组比较,JI-SG组及SG组大鼠术后空腹血糖上升趋势缓慢,3组比较,差异有统计学意义（F=18.3,P＜0.05）.JI-SG组、SG组及对照组大鼠空腹胰岛素水平由术前的（5.2±1.1） mU/L、（5.1±1.2） mU/L、（5.3±0.8） mU/L变化为术后12周的（4.5±1.3）mU/L、（5.6 ±1.4）mU/L、（7.5±1.6） mU/L.JI-SG组呈下降趋势,SG组和对照组呈上升趋势,3组比较,差异有统计学意义（F=7.8,P ＜0.05）.术后12周,JI-SG组大鼠空腹胰岛素水平比SG组低,两组比较,差异有统计学意义（t=6.7,P ＜0.05）.JI-SG组、SG组及对照组大鼠空腹血浆胃饥饿素水平由术前的（223±35） ng/L、（232±36） ng/L、（238±31） ng/L变化为术后12周的（168±20） ng/L、（175±21） ng/L、（223±12） ng/L,JI-SG组和SG组呈下降趋势,3组比较,差异有统计学意义（F=12.3,P＜0.05）.术后12周,JI-SG组胃饥饿素水平与SG组比较,差异无统计学意义（t=0.4,P＞0.05）.JI-SG组、SG组及对照组大鼠空腹血浆GLP-1水平由术前的（1.69 ±0.12） pmol/L、（1.71 ±0.19） pmol/L、（1.69±0.10）pmol/L变化为术后12周的（2.22 ±0.11）pmol/L、（1.81 ±0.12）pmol/L、（1.61 ±0.10） pmol/L.JI-SG组和SG组GLP-1水平呈上升趋势,3组比较,差异有统计学意义（F=5.5,P ＜0.05）.术后12周,JI-SG组GLP-1水平高于SG组,两组比较,差异有统计学意义（t=2.4,P＜0.05）.结论 与单纯SG比较,JI-SG具有更好地减重及改善代谢效果.

Objective To investigate the effects of sleeve gastrectomy （SG） plus side-to-side jejunoileal anastomosis on weight loss and metabolic control in a rat model of type 2 diabetes mellitus.Methods Thirty male Zucker diabetic fatty （ZDF） rats aged 7 weeks were divided into the JI-SG group,the SG group and the control group based on the random number table.Ten rats in the JI-SG group received SG plus side-to-side jejunoileal anastomosis,10 rats in the SG group receive SG and 10 rats in the control group received sham surgery.Body weight and fasting blood glucose were detected at preoperative day 1 and at preoperative week 1,2,4,6,8,10,12.Fasting plasma insulin,ghrelin and glucagon-like peptide 1 （GLP-1） were detected at preoperative day 1 and postoperative week 6 and 12.The measurement data with normal distribution were presented as x ± s.The comparison between groups was analyzed using the LSD-t test and comparisons among many groups were done using ANOVA.The repeated measurement data were analyzed by the repeated measures ANOVA.Results The body weight of rats in the JI-SG,SG and control group were changed from （297.2 ± 2.1） g,（302.0 ± 1.8） g and （296.0 ± 2.1） g before operation to （242.7 ± 13.2） g,（380.4 ± 16.5） g and （440.1 ± 15.1） g at postoperative week 12,there was an upward trend between the control group and the SG group and a steady trend in the JI-SG group,with a significant difference among the 3 groups （F =42.5,P 〈 0.05）.The levels of blood glucose in JI-SG,SG and control group before operation were （11.7 ± 1.7） mmol/L,（11.4 ± 3.1） mmol/L and （12.4 ± 1.5） mmol/L,with no significant difference among the 3 groups （F =18.2,P 〉 0.05）.The levels of blood glucose in JI-SG group,the SG group and the control group were changed from （5.7 ± 0.7） mmol/L,（6.2 ± 1.6） mmol/L and （7.4 ±0.5） mmol/L at postoperative week 1 to （6.9 ± 2.5） mmol/L,（13.9 ± 2.8） mmol/L and （22.2 ± 2.9） mmol/L at postoperative week 12,showing a slow upward trend between the JI-SG group and the SG group,with significant differences among the 3 groups （F =18.3,P 〈0.05）.The levels of fasting insulin in the JI-SG group,the SG group and the control group were changed from （5.2 ± 1.1） mU/L,（5.1 ± 1.2） mU/L and （5.3 ± 0.8） mU/L before operation to （4.5 ± 1.3） mU/L,（5.6 ± 1.4） mU/L and （7.5 ± 1.6） mU/L at postoperative week 12,showing an upward trend between the control group and the SG group and a descending trend in the JI-SG group,with a significant difference （F =7.8,P 〈 0.05）.The levels of insulin in the JI-SG group was lower than that in the SG group （t =6.7,P 〈 0.05）.The levels of ghrelin in the JI-SG group,the SG group and the control group were changed from （223 ± 35）ng/L,（232 ± 36）ng/L,（238 ± 31）ng/L before operation to （168 ± 20） ng/L,（175 ± 21）ng/L,（223 ± 12）ng/L at postoperative week 12,showing a descending trend between the JI-SG group and the SG group,with a significant difference （F =12.3,P 〈 0.05）.There was no significant difference in the levels of ghrelin between the JI-SG group and the SG group （t =0.4,P 〉 0.05）.The levels of GLP-1 in the JI-SG group,the SG group and the control group were changed from （1.69 ± 0.12）pmol/L,（1.71 ± 0.19） pmol/L and （1.69 ± 0.10） pmol/L before operation to （2.22 ± 0.11） pmol/L,（1.81 ± 0.12） pmol/L and （1.61 0.10）pmol/L at postoperative week 12.There was a significant difference and an upward trend in the levels of postoperative GLP-1 among the JI-SG,SG and control group （F =5.5,P 〈 0.05）.The levels of GLP-1 in the JI-SG group were significantly higher than those in the SG group （t =2.4,P 〈 0.05）.Conclusion SG plus side-to-side jejunoileal anastomosis on weight loss and metabolic control has better efficacies compared with SG.