袖状胃切除联合单吻合口十二指肠回肠旁路术或单吻合口双通路吻合术对肥胖合并糖尿病大鼠的疗效及微量营养素缺乏的分析

Analysis of therapeutic effect and micronutrient deficiency of single-anastomosis duodenoileal bypass with sleeve gastrectomy and single anastomosis sleeve ileal bypass in obese rats with type 2 diabetes mellitus

目的对比分析袖状胃切除联合单吻合口十二指肠回肠旁路术(single-anastomosis duodenoileal bypass with sleeve gastrectomy,SADI-S)和袖状胃切除联合单吻合口双通路吻合术(single-anastomosis sleeve ileal,SASI)对肥胖合并糖尿病大鼠的减重、降糖及微量营养素的影响。方法36只Spraque-Dawley大鼠采用高脂饮食喂养1个月并联合低剂量1%链脲佐菌素(35 mg/kg)方法诱导肥胖合并糖尿病大鼠模型,随后将大鼠编号后采用抽签方式随机均分为SADI-S组、SASI组和假手术(sham operation,SO)组3组,然后再以同样的随机方法抽取8只大鼠进行实验观察。于术前和术后1~6个月时每月记录大鼠的体质量、进食量和6 h禁食后的空腹血糖(fasting blood glucose,FBG)水平;同时于术前和术后第1和第6个月时进行口服葡萄糖耐量试验(oral glucose tolerance test,OGTT)和胰岛素抵抗试验(insulin resistance test,ITT)并检测血清胰高血糖素样-1(glucagon like peptide-1,GLP-1)、血红蛋白(hemoglobin,Hb)和白蛋白(albumin,ALB)水平以及维生素B_(12)(vitamin B12,VB12)、钙和铁含量。结果①SADI-S组和SASI组术后1~6个月时的体质量、进食量(除外术后5、6个月)和FBG水平均低于SO组(P<0.05)并且均于术后第1个月时降低明显(P<0.05),而各时点SADI-S组和SASI组比较未见差异有统计学意义(P>0.05)。②SADI-S组和SASI组术后OGTT和ITT血糖水平均低于SO组(P<0.05)且均低于术前(P<0.05),并且SADI-S组在术后第6个时的OGTT血糖水平低于SASI组(P<0.05)。③GLP-1水平在术后第6个月时SADI-S组和SASI组高于SO组(P<0.05)且均高于术前(P<0.05),但未发现SADI-S组和SASI组比较差异有统计学意义(P>0.05)。④SADI-S组和SASI组术后ALB水平均低于SO组(P<0.05)且低于术前,并且在术后第6个月时SADI-S组低于SASI组(P<0.05);而3组间Hb水平比较差异未见有统计学意义(P>0.05)。⑤铁含量在SADI-S组术后第1个月时低于SASI组及SO组(均P<0.05),在第6个月时略有上升而与SASI组比较差异无统计学意义(P>0.05);钙仅在术后第6个月时SADI-S组和SASI组低于SO组(P<0.05)且低于术前(P<0.05),但未发现SADI-S组和SASI组间比较差异有统计学意义(P>0.05);VB12在3组间比较差异未见有统计学意义(P>0.05)。结论对于肥胖合并糖尿病大鼠,SADI-S和SASI具有相似的减重效果,但就长期血糖缓解情况而言,SADI-S组相对优于SASI组,但在对微量营养素影响方面SASI组相对优于SADI-S组。

Objective To compare effectiveness of single-anastomosis duodenoileal bypass with sleeve gastrectomy(SADI-S)and single anastomosis sleeve ileal(SASI)bypass on weight loss and glucose regulating as well as difference in micronutrient deficiency in obese rats with type 2 diabetes mellitus.Methods Thirty-six Spraque-Dawley rats fed with high fat diet combined with intraperitoneal injection of low-dose streptozotocin(35 mg/kg)for 1 month were used to induce obese rats with type 2 diabetes mellitus,then were randomly averagely divided into 3 groups:SADI-S group,SASI group,and sham operation(SO)group.Eight rats from numbered rats of each group were randomly selected to carry out experimental observation.The rats’body weight,food intake,and fasting blood glucose(FBG)were measured from before operation to postoperative 1–6 months.Meanwhile blood was collected before surgery,as well as at month 1 and 6 after surgery for oral glucose tolerance testing(OGTT)and insulin resistance testing(ITT).Serum glucagonlike peptide(GLP-1),hemoglobin,and albumin levels,as well as vitamin B_(12),calcium,and ferrum concentrations were measured before surgery as well as at month 1 and 6 after surgery.Results①The body weight,food intake(except 5–6 months),and FBG level in the SADI-S group and SASI group were lower than the SO group(P<0.05)from 1-to 6-month after operation,and all obviously decreased at month 1 after operation(P<0.05),but there was no statistical differences between the SADI-S group and SASI group(P>0.05).②The postoperative OGTT and ITT blood glucose levels in the SADI-S group and SASI group were lower than those in the SO group(P<0.05)and were lower than those in the preoperative levels(P<0.05),and the SADI-S group had a lower OGTT blood glucose level than the SASI group at month 6 after operation(P<0.05).③The GLP-1 levels of the SADI-S group and SASI group were higher than that of the SO group(P<0.05),and higher than before operation at month 6 after operation(P<0.05),but there was no statistical difference was found between the SADI-S group and SASI group after operation(P>0.05).④The postoperative albumin levels of the SADI-S group and SASI groups=were lower than of the SO group(P<0.05)and were lower than before operation,and albumin level of the SADI-S group was lower than of the SASI group at postoperative month 6(P<0.05);while the hemoglobin had no statistical differences among the 3 groups(P>0.05).⑤The ferrum concentration of the SADI-S group was lower than that of the SASI group and SO group at 1 month after operation(all P<0.05),while it increased slightly at month 6 after operation and had no statistical difference between the SADI-S group and SASI group(P>0.05);the calcium concentrations of the SADI-S group and SASI group only at 6 month after operation were lower than those of the SO group(P<0.05),and were lower as compared with before operation(P<0.05),but no statistical difference was found between the SADI-S group and SASI group(P>0.05);the vitamin B12 had no statistical differences among the 3 groups(P>0.05).Conclusions For obese rats with type 2 diabetes mellitus,SADI-S and SASI have similar weight loss effect.Long-term glucose reduction of SADI-S shows a advantage than SASI,but influence of postoperative micronutrients of SASI is inferior to SASI.