十二指肠空肠旁路术与十二指肠空肠吻合术对2型糖尿病大鼠视黄醇结合蛋白4的作用及意义

The role of duodenal-jejunal anastomosi and duodenal-jejunal bypass on RBP-4 in rats with type 2 diabetes

目的:探讨十二指肠空肠旁路术(duodenal-jejunal bypass,DJB)与十二指肠空肠吻合术(duodenal-jejunal anastomosi,DJA)对2型糖尿病治疗效果的异同及视黄醇结合蛋白4(retinol binding protein-4,RBP-4)和葡萄糖转运蛋白4(glucose transporter-4,GLUT-4)在其中的作用。方法:糖尿病大鼠随机分为DJA组、DJB组和假手术组,测定其手术前后体重、摄食量、空腹血糖、空腹胰岛素、RBP-4水平,评估手术前后糖代谢情况及胰岛素抵抗情况,术后第8周测定GLUT-4水平。结果:与假手术组相比,DJA组和DJB组术后空腹血糖降低,OGTT葡萄糖曲线下面积减少,胰岛素抵抗有所改善,RBP-4水平下降,骨骼肌GLUT-4水平升高。结论:DJB和DJA手术能不依赖摄食量、体重及胰岛素分泌的增加而改善糖尿病大鼠糖代谢,缓解其胰岛素抵抗状态,两者对空腹血糖的改善作用相似,但DJA手术对餐后血糖调节作用较差,可能与术后RBP-4降低、GLUT-4升高幅度不同有关。

Objective： To detect the serum levels of retinol binding protein-4 （RBP-4） and glucose transporter-4 （GLUT-4） in the short-time （8 weeks） after duodenal-jejunal anastomosi （DJA） surgery and duodenal-jejunal bypass （DJB） surgery for type 2 diabetic rats,and attempt to explore theoretical basis and mechanisms of surgical treatment in type 2 diabetes.Methods： Type 2 diabetic rats were divided into the DJA surgery group （n=10）,the DJB surgery group （n=10） and the sham surgery group （n=10）.Weight,food intake,fasting blood glucose,fasting insulin,and RBP-4 level were measured before and after treatment.The glucose metablolism and insulin resistance before and after operation were evaluated.GLUT-4 level was detected at the 8th week after surgery.Results： Compared with the sham surgery group,the DJB and DJA groups showed decreased fasting blood glucose,reduced area under oral glucose tolerance test （OGTT） curve,improved insulin resistance,decreased BRP-4 level,and increased GLUT-4.Conclusion： DJA and DJB operation could significantly improve the glucose metabolism and insulin sensitivity of type 2 diabetic rats,which were independent of the weight loss,but related to decreased RBP-4 and increased GLUT-4 in skeletal muscle.