CAJ | 학술논문

目的比较胃旁路术(GBP)与胆胰转流术(BPD)对非胰岛素依赖性糖尿病大鼠的治疗效果,探讨其机制.方法 40只糖尿病GK大鼠按数字表法随机分为GBP组、BPD组、饮食控制组和对照组,每组10只.GBP组、BPD组分别行GBP及BPD手术；饮食控制组大鼠每天给予基础饲料15 g,自由进水；对照组不限食量.记录手术时间、死亡率.每周测空腹体重.检测治疗前及治疗后1、2、3、4、8、16周的空腹血糖、瘦素、胰岛素样生长因子-1(IGF-1)水平.结果 GBP组平均手术时间为(25±4)min,BPD组为(35±6)min；GBP组大鼠死亡1只,BPD组死亡3只,两组差异均有统计学意义(P值均＜0.01).治疗前各组大鼠血糖、瘦素及IGF-1水平无统计学差异.治疗后对照组大鼠血糖及瘦素均无明显变化.饮食控制组大鼠治疗后2周起血糖及瘦素水平开始下降,第4周时显著降低,并持续至16周(P＜0.05),但血IGF-1水平无明显变化.GBP组与BPD组大鼠治疗后2周起血糖及瘦素水平开始下降,而血IGF-1水平开始升高,并持续至16周[血糖:(6.8±1.0)、(6.3±0.8)mmol/L比(13.9±2.6)、(14.1±2.4)mmol/L;瘦素:(16.1±3.3)、(17.2±3.2)pg/ml比(29.4±3.9)、(29.4±3.9) pg/ml；IGF-1:( 166.1±8.3)、(142.2±8.2) ng/L比(119.4±8.8)、(109.8±7.9)ng/L,P值均＜0.01],但这两组的血糖及瘦素水平无统计学差异；而GBP组大鼠血IGF-1水平较BPD组升高更显著(P＜0.05).结论 GBP和BPD均能较好地控制糖尿病大鼠的血糖水平,其机制可能与瘦素的降低及IGF-1的升高有关.GBP在手术时间、死亡率及增加血IGF-1水平等方面优于BPD.
목적 비교위방로술(GBP)여담이전류술(BPD)대비이도소의뢰성당뇨병대서적치료효과,탐토기궤제.방법 40지당뇨병GK대서안수자표법수궤분위GBP조、BPD조、음식공제조화대조조,매조10지.GBP조、BPD조분별행GBP급BPD수술；음식공제조대서매천급여기출사료15 g,자유진수；대조조불한식량.기록수술시간、사망솔.매주측공복체중.검측치료전급치료후1、2、3、4、8、16주적공복혈당、수소、이도소양생장인자-1(IGF-1)수평.결과 GBP조평균수술시간위(25±4)min,BPD조위(35±6)min；GBP조대서사망1지,BPD조사망3지,량조차이균유통계학의의(P치균＜0.01).치료전각조대서혈당、수소급IGF-1수평무통계학차이.치료후대조조대서혈당급수소균무명현변화.음식공제조대서치료후2주기혈당급수소수평개시하강,제4주시현저강저,병지속지16주(P＜0.05),단혈IGF-1수평무명현변화.GBP조여BPD조대서치료후2주기혈당급수소수평개시하강,이혈IGF-1수평개시승고,병지속지16주[혈당:(6.8±1.0)、(6.3±0.8)mmol/L비(13.9±2.6)、(14.1±2.4)mmol/L;수소:(16.1±3.3)、(17.2±3.2)pg/ml비(29.4±3.9)、(29.4±3.9) pg/ml；IGF-1:( 166.1±8.3)、(142.2±8.2) ng/L비(119.4±8.8)、(109.8±7.9)ng/L,P치균＜0.01],단저량조적혈당급수소수평무통계학차이；이GBP조대서혈IGF-1수평교BPD조승고경현저(P＜0.05).결론 GBP화BPD균능교호지공제당뇨병대서적혈당수평,기궤제가능여수소적강저급IGF-1적승고유관.GBP재수술시간、사망솔급증가혈IGF-1수평등방면우우BPD.
Objective To compare the treatment effects of gastric bypass (GBP) and biliopancrtic diversion (BPD) in non-insulin dependent diabetes mellitus rats,and investigate the mechanism.Methods Forty GK rats with diabetes mellitus were randomly allocated into four groups:GBP group; BPD group; food restriction group ( FR group) and control group with 10 rats in each group.Rats in GBP group and BPD group received GBP and BPD procedures respectively.Rats in FR group were fed with basic feed of 15 g and free access to water.There was no food restriction in rats in control group.The operation time,mortality was recorded.The fasting body weight was measured every week.The plasma glucose,insulin-like growth factor-1 (IGF-1),and leptin concentrations,were measured before treatment and 1,2,3,4,8,16 week after treatment.Results The mean operation time was (25 ± 4) min in GBP group and (35 ± 6) min in BPD group; one rat died in GBP group and 3 rats died in BPD group,and the difference between the two groups was statistically significant (P ＜ 0.01 ).The levels of plasma glucose,IGF-1 and leptin were not statistically significant among these groups before treatment.There was no significant difference in plasma glucose and leptin concentrations in the control group.The levels of plasma glucose and leptin in rats in FR group began to decrease 2 weeks later,at the 4th week,the levels of plasma glucose and leptin was significantly lower than that before treatment,and it lasted for the 16 th week,but the level of IGF-1 were significantly different.The levels of plasma glucose and leptin in rats in GBP group and BPD group began to decrease and IGF-1 began to increase 2 weeks after operation,and it lasted for the 16th week,[plasma glucose:(6.8 ± 1.0),(6.3 ± 0.8 ) mmol/L vs.(13.9±2.6),(14.1 ±2.6)mmol/L; leptin:(16.1±3.3),(17.2±3.2)pg/ml vs.(29.4±3.9)pg/ml,(29.4±3.9); IGF-1:(166.1±8.3),(142.2±8.2)ng/L vs.(119.4±8.8),(109.8±7.9)ng/L,P＜0.01],but the levels of plasma glucose and leptin was not statistically different between the two groups.The level of IGF-1 in GBP group was significantly higher than that in BPD group (P ＜ 0.05).Conclusions Both GBP and BPD can effectively control plasma glucose concentration for rats with diabetes.The possible mechanism is related to decreased leptin and increased IGF-1.Group GBP had a better outcome in operation time,mortality and increasing IGF-1 than those in group BPD.