袖状胃切除加双通道对肥胖合并糖尿病大鼠的疗效及末端食管黏膜的变化

Effect of sleeve gastrectomy-transit bipartition on diabetic rat with obesity and change of terminal esophageal mucosa

目的探究袖状胃切除(sleeve gastrectomy,SG)加双通道(SG-transit bipartition,SG-TB)手术的减重和降糖效果以及对食管反流的保护作用。方法36只雄性Sprague-Dawley大鼠成功通过高脂饮食喂养及腹腔内注射链脲佐菌素(35 mg/kg)的方法诱导肥胖合并2型糖尿病模型,根据手术方式分为SG、SG-TB和假手术(sham operation,SO)组,每组随机选取8只模型相对稳定的大鼠进行实验研究,观察周期共12周。观察术后第12周时大鼠末端食管黏膜的变化,术后每2周测量体质量及进食量,术前及术后第4周和第12周时检测空腹血糖(fasting blood glucose,FBG)及口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)、胰岛素耐量试验(insulin tolerance test,ITT)血糖水平,同时于术前及术后第12周时检测血清胰高血糖素样肽-1和胰岛素水平的变化。结果所有指标术前在3组间比较差异均无统计学意义(P>0.05)。①术后第12周时SG-TB组未发现食管乳头状瘤病,而在SG组观察到较严重的食管乳头状瘤病,且SG-TB组的黏膜高度低于SG组(P<0.05)。②体质量指标从术后第4周开始,SG-TB组及SG组均低于SO组(P<0.05)且此2组均随时间变化总体呈平稳趋势,未发现此2组在体质量减轻方面有明显差别(P>0.05),然而在进食量方面SG-TB组在术后第10周和第12周时高于SG组(P<0.05)。③术后第4周和第12周时SG-TB组和SG组的FBG、OGTT和ITT血糖水平均低于SO组(P<0.05)且二者术后一直平稳,但未发现SG-TB组和SG组在FBG和ITT血糖控制方面差异有统计学意义(P>0.05),而在术后第12周时SG-TB组的OGTT血糖水平低于SG组(P<0.05)。④术后第12周时,SG-TB组和SG组血清胰高血糖素样肽-1水平均高于SO组且高于术前(P<0.05),而胰岛素水平均低于SO组且低于术前(P<0.05)。结论从本研究初步研究结果看,SG-TB术后末端食管黏膜变化较SG手术小,且发现SG-TB手术在血糖控制方面呈现出较SG更优的趋势,但由于样本量等方面的局限性,仍需进一步研究来验证以及需要进一步明确SG-TB手术的抗反流作用。

Objective To investigate effects of sleeve gastrectomy(SG)-transit bipartition(SG-TB)and simple SG on bariatric and anti-diabetic and protective effect on esophagus reflux.Methods A total of 36 male Sprague-Dawley rats were used to successfully induce the obesity with type 2 diabetes mellitus(T2DM)model by dietary feeding and receiving intraperitoneal injection of streptozotocin(35 mg/kg),then were randomly averagely divided into SG,SG-TB,and sham operation(SO)groups according to the surgical methods,and 8 rats from each procedure were randomly selected and included to use for experimental observation.The observation period was 12 weeks.The changes of terminal esophageal mucosa were observed at the 12th week after operation.The body weight and food intake were measured every 2 weeks after operation.The fasting blood glucose(FBG),oral glucose tolerance test(OGTT)and insulin tolerance test(ITT)blood glucose levels were measured before operation and at the 4th and 12th week after operation.And the changes of glucagon like peptide-1(GLP-1)and insulin levels were measured before operation and at the 12th week after operation.Results There were no significant differences in all indexes among the 3 groups before operation(P>0.05).(1)No esophageal papillomatosis was observed in the SG-TB group at the 12th week after operation,but more severe esophageal papillomatosis was observed in the SG group,and the mucosal height in the SG-TB group was lower than that in the SG group(P<0.05).(2)From the 4th week after operation,the body weight and food intake of the SG-TB group and SG group were lower than the SO group(P<0.05),and their changes of these two groups over time were generally stable.While no significant difference was found in the reduction of body weight between the SG-TB group and the SG group(P>0.05),however the food intakes of the SG-TB group were higher than the SG group at the 10th and 12th week after operation(P<0.05).(3)The levels of FBG,OGTT and ITT blood glucoses in the SG-TB group and SG group were lower than in the SO group at the 4th and 12th week after operation(P<0.05)and remained stable after operation.However,no significant difference was found in the FBG and ITT blood glucose level between the SG-TB group and the SG group(P>0.05),while the level of OGTT blood glucose in the SG-TB group was lower than that in the SG group at the 12th week after operation(P<0.05).(4)The levels of GLP-1 in the SG-TB group and SG group were higher than in the SO group and still higher than before operation(P<0.05),while the insulin levels were lower than in the SO group and lower than before operation(P<0.05).Conclusions From preliminary results of this study,change of terminal esophageal mucosa after SG-TB is weaker than that of SG operation,and it is found that SG-TB surgery shows a better trend in blood glucose control as compared with SG operation.However,due to the limitations of sample size,further research and anti-reflux effect of SG-TB operation still need to be verified.