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目的：研究胃转流术能长期控制病态肥胖症患者伴发的2型糖尿病的可能机制。方法：将8周龄的Goto-Kakizaki大鼠分为保留胃容量的胃空肠转流组(GJB组)、空回肠短路组(JIB组)、饮食控制组及对照组,术后观察36周,在设定的多个时间点测定空腹血糖、空腹胰岛素、口服葡萄糖耐量实验(OGTT)、胰岛素耐受实验(ITT)。结果：GJB、JIB2组大鼠进食量与体重变化相近,GJB术前空腹血糖为14．2±2．9mmol/L,术后4周为7．0±0．7mmol/L(P＜0．001),并始终保持较低水平。JIB组术前空腹血糖为13．9±2．5mmol/L．术后4周仍高达13．8±2．6mmol/L且长期维持高水平。GJB组OGTT的血糖AUC较术前减少35%(P＜0．001),JIB组无明显改变。前者ITT的血糖AUC减少47%。饮食控制组减重明显,空腹血糖亦有下降,为7．7±1．4mmol/L,但OGTT和ITT未能得到明显改善。结论：在进食量和体重无明显改变的情况下,GJB仍能较好的控制血糖,提示胃转流术能直接地控制2型糖尿病,十二指肠和上端空肠在2型糖尿病的发病原理和治疗中可能起重要的作用。
Objective: To investigate the possible mechanism of gastric bypass in long-term management of type 2 diabetes associated with morbid obesity. Methods: Goto-Kakizaki rats of 8 weeks old were divided into gastric jejunal bypass group (GJB group), empty ileum short-circuit group (JIB group), diet control group and control group. After 36 weeks of observation, Fasting blood glucose, fasting insulin, oral glucose tolerance test (OGTT) and insulin resistance test (ITT) were measured at various time points. Results: The food intake and body weight of rats in GJB and JIB2 groups were similar. The fasting blood glucose before GJB was 14.2 ± 2.9mmol / L and 7.0 ± 0.7mmol / L 4 weeks after operation (P <0. 001), and always keep a low level. Preoperative fasting blood glucose in JIB group was 13.9 ± 2.5mmol / L. 4 weeks after surgery is still as high as 13.8 ± 2.6mmol / L and long-term to maintain high levels. The blood glucose AUC of OGTT in GJB group decreased 35% compared with preoperative (P <0.001), but no significant change in JIB group. The former ITT blood glucose AUC decreased by 47%. Diet control group significantly reduced weight, fasting blood glucose also decreased to 7.7 ± 1.4mmol / L, but OGTT and ITT failed to be significantly improved. Conclusion: GJB can still control blood sugar better without any significant changes in food intake and body weight, suggesting that gastric bypass can directly control the pathogenesis of type 2 diabetes mellitus, type 2 diabetes mellitus, duodenum and upper jejunum And treatment may play an important role.