CAJ | 학술논문

目的探讨胆胰转流术(BPD)对GK大鼠2型糖尿病的治疗作用及其机制.方法将16只GK大鼠随机分为2组,BPD组10只,假手术(sham-BPD)组6只.检测术前1周及术后1、4、10、26周2组大鼠空腹血糖、血清胰岛素、胰高血糖素样肽-1(GLP-1)和抑胃肽(GIP)浓度；术后10周检测2组大鼠糖耐量及胰岛素敏感性.结果术前2组空腹血糖、血清胰岛素、GLP-1和GIP差异均无统计学意义；与sham-BPD组相比,BPD组空腹血糖水平显著降低(P＜0.05)、血清胰岛素水平差异无统计学意义、糖耐量明显提高、胰岛素敏感性增强；BPD组较术前及sham-BPD组血清GLP-1水平显著上升(较术前,术后1周P=0.0337,术后4周P=0.0002,术后10周P＜0.0001,术后26周P＜0.0001,较sham-BPD组,术后1周P=0.0354,术后4周P=0.0032,术后10周P=0.0001,术后26周P＜0.0001)、GIP水平显著下降(较术前,术后1周P=0.0189,术后4周P=0.0007,术后10周P=0.0003,术后26周P＜0.0001;较sham-BPD组,术后1周P=0.0089,术后4周P=0.0002,术后10周P=0.0006,术后26周P＜0.0001),差异均有统计学意义(P＜0.05).结论 BPD手术对GK大鼠具有降低血糖、改善糖耐量及增强胰岛素敏感性的作用；GLP-1和GIP可能是BPD降低GK大鼠血糖、改善糖尿病相关代谢综合征的原因.
목적 탐토담이전류술(BPD)대GK대서2형당뇨병적치료작용급기궤제.방법 장16지GK대서수궤분위2조,BPD조10지,가수술(sham-BPD)조6지.검측술전1주급술후1、4、10、26주2조대서공복혈당、혈청이도소、이고혈당소양태-1(GLP-1)화억위태(GIP)농도；술후10주검측2조대서당내량급이도소민감성.결과 술전2조공복혈당、혈청이도소、GLP-1화GIP차이균무통계학의의；여sham-BPD조상비,BPD조공복혈당수평현저강저(P＜0.05)、혈청이도소수평차이무통계학의의、당내량명현제고、이도소민감성증강；BPD조교술전급sham-BPD조혈청GLP-1수평현저상승(교술전,술후1주P=0.0337,술후4주P=0.0002,술후10주P＜0.0001,술후26주P＜0.0001,교sham-BPD조,술후1주P=0.0354,술후4주P=0.0032,술후10주P=0.0001,술후26주P＜0.0001)、GIP수평현저하강(교술전,술후1주P=0.0189,술후4주P=0.0007,술후10주P=0.0003,술후26주P＜0.0001;교sham-BPD조,술후1주P=0.0089,술후4주P=0.0002,술후10주P=0.0006,술후26주P＜0.0001),차이균유통계학의의(P＜0.05).결론 BPD수술대GK대서구유강저혈당、개선당내량급증강이도소민감성적작용；GLP-1화GIP가능시BPD강저GK대서혈당、개선당뇨병상관대사종합정적원인.
Objective To investigate the therapeutic effects and mechanism of biliopancreatic diversion (BPD) surgery on type 2 diabetes mellitus(T2DM) in GK rats.Methods 16 GK rats were randomly divided into 2 groups:BPD surgery group included 10 rats undergoing BPD surgery,sham-BPD group included 6 rats undergoing a sham operation.Fasting plasma glucose,insulin,glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide(GIP)were detected one week before BPD surgery and the 1st week,4th week,10th week,26th week after BPD surgery.Oral glucose tolerance test(OGTT) and insulin tolerance test(ITT) were done in the 10th week after BPD surgery.Results There was no statistical difference in fasting plasma glucose,insulin,plasma GLP-1 or GIP between the 2 groups before surgery.Plasma glucose had significant reduction in BPD group compared to that in the sham group(P ＜0.05) and insulin level had no significant difference between the 2 groups.Rats in BPD group had significant improvement in glucose tolerance and insulin sensitivity compared to those in the sham group.Serum level of GLP-1 was significantly elevated in BPD group compared to that before surgery (P =0.0337 at the 1st week after surgery; P =0.0002 at the 4th week after surgery,P ＜ 0.0001 at the 10th week after surgery,P ＜0.0001 at the 26th week after surgery) and that in sham-BPD group(P =0.0354 at the 1st week after surgery,P =0.0032 at the 4th week after surgery,P =0.0001 at the 10th week after surgery,P ＜0.0001 at the 26th week).Serum level of GIP was significantly lowered in BPD group compared to that before surgery(P =0.0189 at the 1st week after surgery; P =0.0007 at the 4th week after surgery,P =0.0003 at the 10th week after surgery,P ＜0.0001 at the 26th week after surgery) and that in sham-BPD group(P =0.0089 at the 1st week after surgery,P =0.0002 at the 4th week after surgery,P =0.0006 at the 10th week after surgery,P ＜0.0001 at the 26th week after surgery).The difference had statistical significance (P ＜0.05).Conclusion BPD surgery can significantly reduce fasting plasma glucose,improve glucose tolerance and insulin sensitivity.The change of serum levels of GLP-1 and GIP may play the major role in BPD treatment of diabetes mellitus.