回肠转位术与Roux-en-Y胃旁路术对非肥胖型2型糖尿病大鼠的血糖及胰高血糖素样肽-1表达的影响

Effect of Ileal Transposition and Roux-en-Y Gastric Bypass on Blood Glucose and Expression of GLP-1 in Rats with Non-Obese Type 2 Diabetes Mellitus

目的对比分析回肠转位术(ileal transposition,IT)与Roux-en-Y胃旁路术(Roux-en-Y gastric bypass,RYGBP)对非肥胖型2型糖尿病(type 2 diabetes mellitus,T 2 DM)GK大鼠模型的血糖控制效果及其对胰高血糖素样肽-1(glucagon-like peptide-1,GLP-1)表达的影响。方法采用随机数字表法将30只雄性正常体质量GK大鼠随机分为IT组、RYGBP组和Sham组,每组10只,记录大鼠术后的并发症发生情况和死亡情况。3组大鼠均于术前,术后1周、2周、1个月、2个月、3个月及6个月检测空腹血糖(FBG)、空腹胰岛素(FINS)、糖化血红蛋白(Hb A 1 c)及GLP-1水平。结果 1并发症发生和死亡。术后Sham组及IT组大鼠均未见并发症发生及死亡。术后仅RYGBP组有5只大鼠发生并发症,其中3只死亡。与Sham组和IT组比较,RYGBP组大鼠的并发症发生率和死亡率均较高(P<0.05)。2 FBG。同组内与术前比较,RYGBP组和IT组大鼠术后1周、2周、1个月、2个月、3个月及6个月时的FBG水平均较低(P<0.05);术后1周、2周、1个月、2个月、3个月及6个月时,RYGBP组和IT组大鼠的FBG水平均低于Sham组(P<0.05),但各时点RYGBP组和IT组比较差异均无统计学意义(P>0.05)。3FINS及Hb A 1 c。同组内与术前比较,RYGBP组和IT组大鼠术后3个月及6个月时的FINS水平均较高(P<0.05),但Hb A 1 c水平均较低(P<0.05);术后3个月和6个月时,RYGBP组和IT组大鼠的FINS水平均高于Sham组(P<0.05),Hb A 1 c水平均低于Sham组(P<0.05),但同时点RYGBP组和IT组比较差异均无统计学意义(P>0.05)。4 GLP-1。同组内与术前比较,RYGBP组和IT组大鼠术后1周、2周、1个月、2个月、3个月及6个月时的GLP-1水平均较高(P<0.05);术后1周、2周、1个月、2个月、3个月及6个月时,RYGBP组和IT组大鼠的GLP-1水平均高于Sham组(P<0.05),但同时点RYGBP组和IT组比较差异均无统计学意义(P>0.05)。结论 IT与RYGBP对非肥胖型T 2 DM GK大鼠均具有显著的降糖作用,但与RYGBP比较,IT的并发症更少,更安全有效。

Objective To compare the effect of ileal transposition （IT） and Roux-en-Y gastric bypass （RYGBP） on blood glucose and expression of glucagon-like peptide-1 （GLP-1） in Goto-Kakizaki （GK） rats with non-obese type 2 diabetes mellitus （T2DM）. Methods Thirty male GK rats were randomized divided into three groups：IT group （n=10）, RYGBP group （n=10）, and Sham group （n=10）. The mortality and complication were observed after surgery. The levels of fasting blood glucose （FBG）, fasting insulin （FINS）, glycosylated hemoglobin （HbA1c）, and GLP-1 were determined before operation, and 1 week, 2 weeks, 1 month, 2 months, 3 months, 6 months after operation in the GK rats of 3 groups. Results ① Mortality and morbility. There was no death and complication occurred in IT group and Sham group, only 5 rats of RYGBP group suffered from complication, and 2 of them died. The mortality and morbility were higher in RYGBP group than those of IT group and Sham group （P〈0.05）. ② FBG. Compared with before operation in the same group, the FBG levels of IT group and RYGBP group in 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after operation were all lower （P〈0.05）. In 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after operation, FBG levels of IT group and RYGBP group were all lower than those of Sham group at the same time point （P〈0.05）, but there was no significant difference between IT group and RYGBP group at the 6 time points （P〉0.05）. ③ FINS and HbA1c. Compared with before operation in the same group, the FINS levels of IT group and RYGBP group in 3 months and 6 months after operation were higher than those of Sham group （P〈0.05）, HbA1c levels of IT group and RYGBP group were both lower at the 2 time points （P〈0.05）. In 3 months and 6 months after operation, FINS levels of IT group and RYGBP group were both higher, and HbA1c levels were both lower than corresponding indexes of Sham group at the same time point （P〈0.05）, but there was no significant difference between IT group and RYGBP group at the 2 time points （P〉0.05）. ④ GLP-1. Compared with before operation in the same group, the GLP-1 levels of IT group and RYGBP group in 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after operation were all higher （P〈0.05）. In 1 week, 2 weeks, 1 month, 2 months, 3 months, and 6 months after operation, GLP-1 levels of IT group and RYGBP group were both higher than those of Sham group at the same time point （P〈0.05）, but there was no significant difference between IT group and RYGBP group at the 6 time points （P〉0.05）. Conclusion IT and RYGBP have a significant hypoglycemic effect on non-obese T2DM GK rats, but IT has lower mortality and morbility, which is more effective and safer, comparing with RYGBP.