肥胖合并糖尿病大鼠袖状胃切除加双通道术与胆胰转流十二指肠转位术后的疗效及营养状况对比研究

Comparison of effectiveness and nutritional condition in obese T2DM rats after sleeve gastrectomy-transit bipartition and biliopancreatic diversion with duodenal switch

目的对比分析肥胖合并2型糖尿病(T2DM)大鼠袖状胃切除加双通道术(SG-TB)与胆胰转流十二指肠转位术(BPD-DS)的减重降糖疗效及术后营养状况。方法采取高脂饮食喂养1个月联合低剂量链脲佐菌素(35 mg/kg)腹腔内注射诱导肥胖合并T2DM大鼠模型。将24只建模成功后的大鼠随机分为SG-TB组、BPD-DS组及假手术(SHAM)组,每组8只。术前和术后1~3个月每月测定大鼠的进食量和体重,检测空腹血糖(FBG),行口服葡萄糖耐量试验(OGTT)和胰岛素耐量试验(ITT)。术前和术后1、3个月时检测胰高血糖素样肽(GLP-1)、胰岛素(insulin)水平,计算稳态模型胰岛素抵抗(HOMA-IR)指数,检测血清白蛋白(ALB)、钙(Ca)、铁(Fe)、维生素B_(12)(VB_(12))含量。结果①术前SG-TB组、BPD-DS组及SHAM组各项指标比较,差异无统计学意义(P>0.05)。②术后1~3个月SG-TB组和BPD-DS组体重和进食量均低于术前水平,较同一时间点SHAM组更低,差异有统计学意义(P<0.05),其中术后各时间点SG-TB组体重显著高于BPD-DS组,术后1个月时SG-TB组进食量高于BPD-DS组(P<0.05)。③术后各时间点SG-TB组和BPD-DS组的FBG、OGTT AUC、ITT AUC均低于SHAM组,差异有统计学意义(P<0.05);但SG-TB组和BPD-DS组比较差异无统计学意义(P>0.05)。④术后1个月BPD-DS组、术后3个月SG-TB组和BPD-DS组GLP-1 AUC显著高于SHAM组(P<0.05);术后SG-TB组GLP-1 AUC低于BPD-DS组,但差异无统计学意义(P>0.05)。术后SG-TB组和BPD-DS组Insulin AUC、HOMA-IR均显著低于SHAM组(P<0.05),其中术后1个月SG-TB组Insulin AUC显著高于BPD-DS组,差异有统计意义(P<0.05)。⑤术后1、3个月SG-TB组和BPD-DS组Fe含量较SHAM组明显降低(P<0.05),但2组比较差异无统计意义(P>0.05)。术后1、3个月BPD-DS组Ca含量均较SHAM组明显降低,术后3个月SG-TB组Ca含量明显低于SHAM组(P<0.05)。术后1个月SG-TB组ALB显著低于SHAM组,术后1、3个月BPD-DS组ALB显著低于SG-TB组和SHAM组(P<0.05)。术后SG-TB组和BPD-DS组VB_(12)含量较SHAM组降低,但差异无统计学意义(P>0.05)。结论SG-TB手术操作简便,在改善血糖方面与BPD-DS术效果相近,但发生营养不良的风险稍低,是肥胖合并T2DM者较好的术式选择。

Objective To compare the weight loss,hypoglycemic effect and nutritional condition of type 2 diabetes mellitus(T2DM)rats with obesity after sleeve gastrectomy-transit bipartition(SG-TB)and biliopancreatic diversion with duodenal switch(BPD-DS).Methods T2DM diabetes rats with obesity were induced through intraperitoneal injection of a low-dose streptozotocin(35 mg/kg)using high-fat diet for one month.Twenty-four successfully modeled rats were randomly divided into three groups(n=8):a SG-TB group,a BPD-DS group and a sham operation(SHAM)group.Before operation and at post-operative 1 to 3 months,their food intake and body weight were measured;the fasting blood glucose(FBG)were measured;and oral glucose tolerance test(OGTT)and insulin resistance test(ITT)were performed.Before operation and post-operative 1 and 3 months,glucagon-like peptide(GLP-1)and insulin were detected;homeostasis model assessment of insulin resistance(HOMA-IR)was calculated;and the contents of serum albumin(ALB),calcium(Ca),ferrum(Fe),and vitamin B_(12)(VB_(12))were detected.Results①There was no statistical difference in each indicators among the SG-TB group,the BPD-DS group and the SHAM group before operation(P>0.05).②One to three months after surgery,the body weight and food intake of the SG-TB and BPD-DS groups were remarkably lower than those before surgery,and lower than those of the SHAM group at the corresponding time points(P<0.05).Compared with the BPD-DS group,the SG-TB group showed increases in body weight at post-operative 1-3 months,and increases in food intake one month after operation(P<0.05).③Both the SG-TB and BPD-DS groups showed significantly lower FBG,OGTT AUC and ITT AUC than the SHAM group(P<0.05).But no statistical difference was found between the SG-TB and BPD-DS groups(P>0.05).④Compared with the SHAM group,remarkable increases in GLP-1 AUC were found in the BPD-DS group one month after operation and in the SG-TB group at post-operative 3 months(P<0.05).The SG-TB group showed lower GLP-1 AUC than the BPD-DS group,without statistical difference(P>0.05).Both the SG-TB and BPD-DS groups showed significantly lower Insulin AUC and HOMA-IR than the SHAM group(P<0.05).The insulin AUC of the SG-TB group was higher than that of BPD-DS groups at post-operative 1 month(P<0.05).⑤Both the SG-TB and BPD-DS groups showed significantly lower Fe content than the SHAM group at post-operative 1 and 3 months(P<0.05),but no statistical difference was found between the SG-TB and BPD-DS groups(P>0.05).Compared with the SHAM group,the BPD-DS group showed deceases in Ca content at post-operative 1 and 3 month(P<0.05),while the SG-TB group showed deceases in Ca content three months after operation(P<0.05).The SG-TB group presented lower ALB than the SHAM group one month after operation,while the BPD-DS group presented lower ALB than the SB-TB and SHAM groups at post-operative 1 and 3 month(P<0.05).After operation,both the SG-TB and BPD-DS groups showed lower VB_(12) content than the SHAM group,without statistical differences(P>0.05).Conclusions SG-TB is easy to operate and has similar effect in improving blood glucose as BPD-DS,with a slightly lower risk of malnutrition than BPD-DS.