中华普通外科杂志
中華普通外科雜誌
중화보통외과잡지
CHINESE JOURNAL OF GENERAL SURGERY
2010年
1期
13-16
,共4页
王瑜%王烈%张再重%邓治洲%邹忠东
王瑜%王烈%張再重%鄧治洲%鄒忠東
왕유%왕렬%장재중%산치주%추충동
糖尿病,2型%胃肠吻合术%血糖%葡糖耐量试验
糖尿病,2型%胃腸吻閤術%血糖%葡糖耐量試驗
당뇨병,2형%위장문합술%혈당%포당내량시험
Diabetes mellitus,Type 2%Gastroenterostomy%Blood glucose%Glucose tolerance test
目的 观察不同肠段小肠旷置术对2型糖尿病大鼠血糖和糖耐量的影响.方法 将40只Goto-Kakizaki(GK)大鼠随机分为旷置十二指肠组(A组)、旷置十二指肠和近端空肠组(B组)、旷置十二指肠和全部空肠组(C组)、旷置次全小肠组(D组)和假手术组(SO组)5组,每组8只.测定各组大鼠术前及术后1、3、6、12、24周空腹血糖;用葡萄糖3 g/kg灌胃,测定各组大鼠术前及术后1、24周口服葡萄糖后0、30、60、120和180 min耐糖血糖值,描制血糖值随时间变化曲线,计算糖耐量曲线下面积.结果 与术前比较,各旷置组术后各时间点空腹血糖、糖耐量血糖峰值和糖耐量曲线下面积均明显减少(B组术前和术后1周空腹血糖分别为(9.0±2.4)mmoL/L和(4.4±1.0)mmol/L、糖耐最血糖峰值和糖耐量曲线下面积分别为(20.8±3.1)mmol/L和(10.3±2.0)mmol/L、(2658±417)mmol·min/L和(1324±317)mmol·min/L,P＜0.05或P＜0.01);SO组空腹血糖在术后1、3、6周未发生明显变化(P＞0.05),术后12周(9.1±2.4)mmol/L、24周(10.0±2.3)mmol/L显著高于术前(8.1±1.9)mmol/L,P＜0.01);与术前比较,SO组糖耐量血糖峰值和糖耐量曲线下面积在术后1周未发现明显变化(P＞0.05),术后24周糖耐量血糖峰时后移、峰值增高(25.6±2.0)mmol/L比(21.4±2.7)mmol/L,糖耐量曲线下面积明显增加(3422±360)mmol·min/L比(2667±377)mmol·min/L,P＜0.01.与SO组比较,各旷置组术后各时间点空腹血糖、糖耐最血糖峰值和糖耐量曲线下面积均较SO组显著下降(P＜0.05或P＜0.01).各旷置组之间比较,B组术后各时间点空腹血糖、糖耐最血糖峰值和糖耐量曲线下面积均显著低于A组[术后24周B组和A组空腹血糖分别为(4.6±1.2)mmol/L和(6.2±1.5)mmoL/L、糖耐量血糖峰值分别为(9.7±2.2)mmol/L和(12.4±1.7)mmoL/L、糖耐量曲线下面积分别为(1230±293)mmol·min/L和(1599±264)mmol·min/L,P＜0.05或P＜0.01],对血糖控制和糖耐量改善效果优于A组,但与C组和D组相比差异均无统计学意义(P＞0.05).结论 小肠旷置术可控制2型糖尿病大鼠的血糖并改善糖耐量,其中旷置十二指肠和近端空肠是临床可行的术式.
目的 觀察不同腸段小腸曠置術對2型糖尿病大鼠血糖和糖耐量的影響.方法 將40隻Goto-Kakizaki(GK)大鼠隨機分為曠置十二指腸組(A組)、曠置十二指腸和近耑空腸組(B組)、曠置十二指腸和全部空腸組(C組)、曠置次全小腸組(D組)和假手術組(SO組)5組,每組8隻.測定各組大鼠術前及術後1、3、6、12、24週空腹血糖;用葡萄糖3 g/kg灌胃,測定各組大鼠術前及術後1、24週口服葡萄糖後0、30、60、120和180 min耐糖血糖值,描製血糖值隨時間變化麯線,計算糖耐量麯線下麵積.結果 與術前比較,各曠置組術後各時間點空腹血糖、糖耐量血糖峰值和糖耐量麯線下麵積均明顯減少(B組術前和術後1週空腹血糖分彆為(9.0±2.4)mmoL/L和(4.4±1.0)mmol/L、糖耐最血糖峰值和糖耐量麯線下麵積分彆為(20.8±3.1)mmol/L和(10.3±2.0)mmol/L、(2658±417)mmol·min/L和(1324±317)mmol·min/L,P＜0.05或P＜0.01);SO組空腹血糖在術後1、3、6週未髮生明顯變化(P＞0.05),術後12週(9.1±2.4)mmol/L、24週(10.0±2.3)mmol/L顯著高于術前(8.1±1.9)mmol/L,P＜0.01);與術前比較,SO組糖耐量血糖峰值和糖耐量麯線下麵積在術後1週未髮現明顯變化(P＞0.05),術後24週糖耐量血糖峰時後移、峰值增高(25.6±2.0)mmol/L比(21.4±2.7)mmol/L,糖耐量麯線下麵積明顯增加(3422±360)mmol·min/L比(2667±377)mmol·min/L,P＜0.01.與SO組比較,各曠置組術後各時間點空腹血糖、糖耐最血糖峰值和糖耐量麯線下麵積均較SO組顯著下降(P＜0.05或P＜0.01).各曠置組之間比較,B組術後各時間點空腹血糖、糖耐最血糖峰值和糖耐量麯線下麵積均顯著低于A組[術後24週B組和A組空腹血糖分彆為(4.6±1.2)mmol/L和(6.2±1.5)mmoL/L、糖耐量血糖峰值分彆為(9.7±2.2)mmol/L和(12.4±1.7)mmoL/L、糖耐量麯線下麵積分彆為(1230±293)mmol·min/L和(1599±264)mmol·min/L,P＜0.05或P＜0.01],對血糖控製和糖耐量改善效果優于A組,但與C組和D組相比差異均無統計學意義(P＞0.05).結論 小腸曠置術可控製2型糖尿病大鼠的血糖併改善糖耐量,其中曠置十二指腸和近耑空腸是臨床可行的術式.
목적 관찰불동장단소장광치술대2형당뇨병대서혈당화당내량적영향.방법 장40지Goto-Kakizaki(GK)대서수궤분위광치십이지장조(A조)、광치십이지장화근단공장조(B조)、광치십이지장화전부공장조(C조)、광치차전소장조(D조)화가수술조(SO조)5조,매조8지.측정각조대서술전급술후1、3、6、12、24주공복혈당;용포도당3 g/kg관위,측정각조대서술전급술후1、24주구복포도당후0、30、60、120화180 min내당혈당치,묘제혈당치수시간변화곡선,계산당내량곡선하면적.결과 여술전비교,각광치조술후각시간점공복혈당、당내량혈당봉치화당내량곡선하면적균명현감소(B조술전화술후1주공복혈당분별위(9.0±2.4)mmoL/L화(4.4±1.0)mmol/L、당내최혈당봉치화당내량곡선하면적분별위(20.8±3.1)mmol/L화(10.3±2.0)mmol/L、(2658±417)mmol·min/L화(1324±317)mmol·min/L,P＜0.05혹P＜0.01);SO조공복혈당재술후1、3、6주미발생명현변화(P＞0.05),술후12주(9.1±2.4)mmol/L、24주(10.0±2.3)mmol/L현저고우술전(8.1±1.9)mmol/L,P＜0.01);여술전비교,SO조당내량혈당봉치화당내량곡선하면적재술후1주미발현명현변화(P＞0.05),술후24주당내량혈당봉시후이、봉치증고(25.6±2.0)mmol/L비(21.4±2.7)mmol/L,당내량곡선하면적명현증가(3422±360)mmol·min/L비(2667±377)mmol·min/L,P＜0.01.여SO조비교,각광치조술후각시간점공복혈당、당내최혈당봉치화당내량곡선하면적균교SO조현저하강(P＜0.05혹P＜0.01).각광치조지간비교,B조술후각시간점공복혈당、당내최혈당봉치화당내량곡선하면적균현저저우A조[술후24주B조화A조공복혈당분별위(4.6±1.2)mmol/L화(6.2±1.5)mmoL/L、당내량혈당봉치분별위(9.7±2.2)mmol/L화(12.4±1.7)mmoL/L、당내량곡선하면적분별위(1230±293)mmol·min/L화(1599±264)mmol·min/L,P＜0.05혹P＜0.01],대혈당공제화당내량개선효과우우A조,단여C조화D조상비차이균무통계학의의(P＞0.05).결론 소장광치술가공제2형당뇨병대서적혈당병개선당내량,기중광치십이지장화근단공장시림상가행적술식.
Objective To investigate the effect of small intestine exclusion surgery on blood glucose and oral glucose tolerance test (OGTT) in Goto-Kakizaki (GK) rat with type Ⅱ diabetes mellitus.Methods 40 GK rats were randomly divided into 5 groups:duodenal bypass (Group A,n = 8),duodenaljejunal bypass (Group B,n = 8),duodenum and total jejunum exclusion (Group C,n = 8),sub-total small intestine exclusion (Group D,n = 8),and sham-operation (Group SO,n=8).All rats were observed for 24 weeks after surgery.Fasting blood glucose was tested at 0,1,3,6,12,and 24 wk.OGTT was performed at 0,1,and 24 wk.After the administration of 3 g/kg glucose by oral gavage,blood glucose was measured in conscious rats before (baseline) and after 30,60,120,and 180 minutes.Areas under curves (AUC) were calculated by trapezoidal integration.Results Rats in group A,B,C and D had lower fasting blood glucose levels and better oral glucose tolerance as shown by lower peak and area-under-thecurve (AUC) glucose values through the entire follow-up period[group B (fasting blood glucose:(9.0±2.4) mmol/L vs.(4.4±1.0) mmol/L;OGTT peak:(20.8±3.1) mmol/L vs.(10.3±2.0) mmol/L;AUC:(2658±417) mmol·min/L vs.(1324±317) mmo·min/L,P ＜0.05 or P ＜0.01].Fasting blood glucose had no differences before 12 wk and significantly increased at 12 (9.1±2.4) mmol/L and 24 wk (10.0±2.3) mmol/L in group SO (preoperative values were (8.1±1.9) mmol/L,P ＜ 0.01.There was no differences in oral glucose tolerance as shown by lower peak and area-under-the-curve (AUC) glucose values between 0 and 1 wk (P＞0.05),while the oral glucose tolerance become worse as shown by the delay of peak,higher peak (25.6±2.0) mmoL/L vs.(21.4±2.7) mmoL/l,and AUC (3422±360) mmol·min/L vs.(2667±377) mmol·min/L.Glucose values in group SO at 24 wk compared to preoperatively (P＜0.01).Rats in group A,B,C,and D had lower fasting blood-glucose and better oral glucose tolerance compared with sham-operated group through the entire follow-up period (P＜0.05 or P＜0.01).Rats in group B had lower fasting blood-glucose and better oral glucose tolerance compared to those in group A while the effect on diabetes control in group B,C and D were similar to one another (P＞0.05).Conclusion Small intestinal exclusion containing proximal gut was effective for glucose control and improving gucose tolerance,duodeno-jejunal bypass may be applicable for diabetes control in clinical setting.
