中国实用外科杂志

中国实用外科杂志

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胃袖状切除术加空肠-回肠旁路术对肥胖合并糖尿病大鼠体重和代谢调节作用研究

沈运龙1，章    雄1，宋耀军2，王月倩3，乔正东3，曹    婷3，梁永俊3，高黎黎3，张    鹏4   

  1. 1复旦大学附属浦东医院普外科，上海 201399；2陕西省人民医院输血科，陕西西安710068；3复旦大学附属浦东医院医学科研与创新中心，上海 201399；4首都医科大学附属北京友谊医院普通外科中心，北京 100050
  • 出版日期:2019-04-01 发布日期:2019-04-04

  • Online:2019-04-01 Published:2019-04-04

摘要：

目的    研究胃袖状切除术（SG）加空肠-回肠旁路术（JIB）对大鼠体重及糖代谢的影响及其机制。方法  于2018年9-11月在复旦大学附属浦东医院完成研究。将12只肥胖合并2型糖尿病（ZDF，fa/fa）大鼠随机等分为两组，分别行SG+JIB（SG+JIB组）和SG+假手术（SG+Sham组）。另有5只ZDF（fa/+）大鼠作为正常对照组。检测术前及术后2、4周大鼠的体重、空腹血糖、摄食量、口服糖耐量试验（OGTT）以及血浆胰高血糖素样肽-1（GLP-1）水平的变化。结果    SG+JIB组与SG+Sham组大鼠术前基线差异无统计学意义（P>0.05）。与SG+Sham组相比，SG+JIB组术后2周（17.3 mmol/L vs. 8.7 mmol/L）、4周（21.4 mmol/L vs. 11.9 mmol/L）空腹血糖均显著降低（P<0.0001），口服糖耐量也明显改善，两组血糖曲线下面积（180 min总和）在术后2周分别为4221和2964（P<0.0001），术后4周分别为4104和3388（P<0.01）。同时，术后4周时SG+JIB组GLP-1水平显著高于SG+Sham组（64.6 pmol/L vs. 30.5 pmol/L，P<0.001）。SG+JIB组大鼠每日摄食量和体重仅在术后2周较SG+Sham组减少，术后4周两组差异无统计学意义（P>0.05）。结论    SG+JIB手术可进一步增强SG手术的代谢调节作用，然而对于体重并无显著的额外减轻，建议将SG+JIB手术推荐给需要进一步增强代谢调节的病人，而不建议推荐给以额外降低体重为目的的病人。

关键词: 肥胖症, 2型糖尿病, 胃袖状切除术, 空肠-回肠旁路术, 胰高血糖素样肽-1

Abstract:

Effects of Sleeve Gastrectomy with Jejunal-Ileal Bypass on Metabolism and Body Weight in Zucker Diabetic Fatty Rats        SHEN Yun-long*，ZHANG Xiong，SONG Yao-jun， et al. *Department of Surgery，Shanghai Pudong Hospital，Fudan University，Shanghai 201399，China
Corresponding author：ZHANG Peng，E-mail：zhangpg@yahoo.com
Abstract    Objective    To evaluate the effects of jejunal-ileal bypass (JIB) in addition to sleeve gastrectomy (SG) on glycemic regulation and body weight in Zucker Diabetic Fatty (ZDF) rats and underlying mechnisms. Methods    Twelve ZDF (fa/fa) rats were randomly divided into two groups based upon the procedure performed including sleeve gastrectomy plus jejunal-ileal bypass surgery group (SG+JIB，n=6) and sleeve gastrectomy plus sham procedure group (SG+Sham，n=6). In addition，five healthy ZDF(fa/+) rats were employed as normal controls. Body weight，fasting blood glucose，food intake，oral glucose tolerance test and plasma GLP-1 levels were measured before surgery and at 2 and 4 weeks after surgery. Results    Preoperatively，all baseline parametes had no statistical difference between SG+JIB and SG+Sham groups. In comparison with SG+Sham group，fasting plasma glucose levels at postoperative week 2 (17.3 mmol/L vs. 8.7 mmol/L) and 4 （21.4 mmol/L vs. 11.9 mmol/L）were significantly lower in SG+JIB group（P<0.0001). Oral glucose tolerace was significantly improved，represented by glucose excursion area under curve for 180 minutes period  (4221 vs. 2964，P<0.0001 at postoperative week 2；and 4104 vs. 3388，P<0.01 at postoperative week 4). Simutaneously，plasma GLP-1 levels were significantly higher in SG+JIB group than SG+Sham group (64.58pmol/L v.s. 30.52pmol/L，P<0.001). However，SG+JIB had less food intake and body weight only decreased at postoperative week 2，but not at week 4.  Conclusion    By adding JIB onto SG，the metabolic regulation capability is able to be furtherly enhanced. However，it seems that there is not additional benefit in weight loss. Therefore，based upon these results，we suggest that SG+JIB should be recommended to the patients who needs additional metabolic effects，but not to the patients for the purpose of additional weight loss above SG alone.

Key words: obesity, type 2 diabetes mellitus (T2DM), sleeve gastrectomy（SG）, jejunal-ileal bypass(JIB), glucagon like peptide-1