• 華中科技大學(xué)同濟(jì)醫(yī)學(xué)院附屬同濟(jì)醫(yī)院整形外科（湖北武漢 430030）;

目的探討胃袖狀切除術(shù)的降糖作用及其作用機(jī)理。方法按照隨機(jī)數(shù)字表達(dá)法將非肥胖的2型糖尿病大鼠(GK大鼠)分為袖狀胃切除組(SG組)、假手術(shù)組(SO組)、飲食配對(duì)組(PF組)和空白對(duì)照組(BC組)。動(dòng)態(tài)觀察術(shù)前和術(shù)后24周內(nèi)各組大鼠體重、空腹血糖、葡萄糖耐量(口服葡萄糖耐量試驗(yàn),OGTT)、胰島素耐量(胰島素耐量試驗(yàn),ITT)及胰島素、生長(zhǎng)激素釋放肽ghrelin和胰高血糖素樣肽-1(GLP-1)水平的變化。結(jié)果自術(shù)后4周起SG組和PF組的體重增量開(kāi)始明顯小于SO組(P lt;0.01)。自術(shù)后2周起SG組的空腹血糖水平較其他3組明顯降低(P lt;0.05)。自術(shù)后2周起SG組對(duì)葡萄糖的耐量較術(shù)前和其他3組相應(yīng)時(shí)相明顯改善(P lt;0.01)。術(shù)后第6周SG組對(duì)胰島素的敏感性較SO組明顯改善（P lt;0.05,P lt;0.01）。術(shù)后2～24周SG組與SO組比較,胰島素水平的差異均無(wú)統(tǒng)計(jì)學(xué)意義(P gt;005),ghrelin水平明顯下降(P lt;0.01),GLP-1水平明顯升高(P lt;0.01)。結(jié)論 胃袖狀切除術(shù)的降糖效果確切，能夠獨(dú)立于體重的變化而直接有效地降低血糖; 術(shù)后ghrelin水平下降及GLP-1水平升高可能是胃袖狀切除降糖的主要機(jī)理。

引用本文： 朱占永,嚴(yán)玲玲,吳丹,羅曉,吳毅平. 胃袖狀切除對(duì)GK大鼠血糖、ghrelin和胰高血糖素樣肽-1水平的影響. 中國(guó)普外基礎(chǔ)與臨床雜志, 2011, 18(6): 603-609. doi: 復(fù)制

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2. Gumbs AA, Gagner M, Dakin G, et al. Sleeve gastrectomy for morbid obesity [J]. Obes Surg, 2007, 17(7): 962969.
3. Sammour T, Hill AG, Singh P, et al. Laparoscopic sleeve gastrectomy as a singlestage bariatric procedure [J]. Obes Surg, 2010, 20(3): 271275.
4. Pruessner JC, Kirschbaum C, Meinlschmid G, et al. Two formulas for computation of the area under the curve represent measures of total hormone concentration versus timedependent change [J]. Psychoneuroendocrinology, 2003, 28(7): 916931.
5. Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion [J]. World J Surg, 1998, 22(9): 936946.
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7. Pereferrer FS, Gonzàlez MH, Rovira AF, et al. Influence of sleeve gastrectomy on several experimental models of obesity: metabolic and hormonal implications [J]. Obes Surg, 2008, 18(1): 97108.
8. Schlager A, Khalaileh A, Mintz Y, et al. A mouse model for sleeve gastrectomy: applications for diabetes research [J]. Microsurgery, 2011, 31(1): 6671.
9. Reavis KM, Hinojosa MW, Smith BR, et al. Singlelaparoscopic incision transabdominal surgery sleeve gastrectomy [J]. Obes Surg, 2008, 18(11): 14921494.
10. Lee WJ, Ser KH, Chong K, et al. Laparoscopic sleeve gastrectomy for diabetes treatment in nonmorbidly obese patients: efficacy and change of insulin secretion [J]. Surgery, 2010, 147(5): 664669.
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12. GillRandall R, Adams D, Ollerton RL, et al. Type 2 diabetes mellitus-genes or intrauterine environment? An embryo transfer paradigm in rats [J]. Diabetologia, 2004, 47(8): 13541359.
13. de Bona Castelan J, Bettiol J, d’Acampora AJ, et al. Sleeve gastrectomy model in Wistar rats [J]. Obes Surg, 2007, 17(7): 957961.
14. 鄧治洲, 王烈, 林憶陽(yáng), 等. 胃轉(zhuǎn)流術(shù)對(duì)非肥胖型2型糖尿病的療效觀察及其對(duì)胰高血糖素樣肽1的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(6): 466469.
15. Patriti A, Facchiano E, Sanna A, et al. The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery [J]. Obes Surg, 2004, 14(6): 840848.
16. Purnell JQ, Flum DR. Bariatric surgery and diabetes: who should be offered the option of remission? [J]. JAMA, 2009, 301(15): 15931595.
17. Polyzogopoulou EV, Kalfarentzos F, Vagenakis AG, et al. Restoration of euglycemia and normal acute insulin response to glucose in obese subjects with type 2 diabetes following bariatric surgery [J]. Diabetes, 2003, 52(5): 10981103.
18. Vetter ML, Cardillo S, Rickels MR, et al. Narrative review: effect of bariatric surgery on type 2 diabetes mellitus [J]. Ann Intern Med, 2009, 150(2): 94103.
19. Rizzello M, Abbatini F, Casella G, et al. Early postoperative insulinresistance changes after sleeve gastrectomy [J]. Obes Surg, 2010, 20(1): 5055.
20. Cummings DE, Overduin J. Gastrointestinal regulation of food intake [J]. J Clin Invest, 2007, 117(1): 1323.
21. Cummings DE, Shannon MH. Roles for ghrelin in the regulation of appetite and body weight [J]. Arch Surg, 2003, 138(4): 389396.
22. Kageyama H, Funahashi H, Hirayama M, et al. Morphological analysis of ghrelin and its receptor distribution in the rat pancreas [J]. Regul Pept, 2005, 126(12): 6771.
23. Dezaki K, Kakei M, Yada T. Ghrelin uses Galphai2 and activates voltagedependent K+ channels to attenuate glucoseinduced Ca2+ signaling and insulin release in islet betacells: novel signal transduction of ghrelin [J]. Diabetes, 2007, 56(9): 23192327.
24. Pykk SM, Kellokoski E, Hrkk S, et al. Low plasma ghrelin is associated with insulin resistance, hypertension, and the prevalence of type 2 diabetes [J]. Diabetes, 2003, 52(10): 25462553.
25. Nslund E, Kral JG. Impact of gastric bypass surgery on gut hormones and glucose homeostasis in type 2 diabetes [J]. Diabetes, 2006, 55(Supplement 2): S92S97.
26. D’Alessio DA, Vahl TP. Glucagonlike peptide 1: evolution of an incretin into a treatment for diabetes [J]. Am J Physiol Endocrinol Metab, 2004, 286(6): E882E890.
27. Li Y, Cao X, Li LX, et al. BetaCell Pdx1 expression is essential for the glucoregulatory, proliferative, and cytoprotective actions of glucagonlike peptide1 [J]. Diabetes, 2005, 54(2): 482491.
28. Berthoud HR. Paying the price for eating ice cream: is excessive GLP1 signaling in the brain the culprit? [J]. Endocrinology, 2008, 149(10): 47654767.
29. Baggio LL, Drucker DJ. Biology of incretins: GLP1 and GIP [J]. Gastroenterology, 2007, 132(6): 21312157.
30. 賈乾斌, 汪靜, 趙紀(jì)春, 等. 胰升血糖素樣肽1對(duì)肝切除術(shù)后葡萄糖耐量的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2001, 8(4): 215217.
31. Micic D, Duntas L, Cvijovic G, et al. Ghrelin and the enteroinsular axis in healthy men [J]. Hormones (Athens), 2007, 6(4): 321326.
  1. 1. Vidal J, Ibarzabal A, Romero F, et al. Type 2 diabetes mellitus and the metabolic syndrome following sleeve gastrectomy in severely obese subjects [J]. Obes Surg, 2008, 18(9): 10771082.
  2. 2. Gumbs AA, Gagner M, Dakin G, et al. Sleeve gastrectomy for morbid obesity [J]. Obes Surg, 2007, 17(7): 962969.
  3. 3. Sammour T, Hill AG, Singh P, et al. Laparoscopic sleeve gastrectomy as a singlestage bariatric procedure [J]. Obes Surg, 2010, 20(3): 271275.
  4. 4. Pruessner JC, Kirschbaum C, Meinlschmid G, et al. Two formulas for computation of the area under the curve represent measures of total hormone concentration versus timedependent change [J]. Psychoneuroendocrinology, 2003, 28(7): 916931.
  5. 5. Scopinaro N, Adami GF, Marinari GM, et al. Biliopancreatic diversion [J]. World J Surg, 1998, 22(9): 936946.
  6. 6. Moo TA, Rubino F. Gastrointestinal surgery as treatment for type 2 diabetes [J]. Curr Opin Endocrinol Diabetes Obes, 2008, 15(2): 153158.
  7. 7. Pereferrer FS, Gonzàlez MH, Rovira AF, et al. Influence of sleeve gastrectomy on several experimental models of obesity: metabolic and hormonal implications [J]. Obes Surg, 2008, 18(1): 97108.
  8. 8. Schlager A, Khalaileh A, Mintz Y, et al. A mouse model for sleeve gastrectomy: applications for diabetes research [J]. Microsurgery, 2011, 31(1): 6671.
  9. 9. Reavis KM, Hinojosa MW, Smith BR, et al. Singlelaparoscopic incision transabdominal surgery sleeve gastrectomy [J]. Obes Surg, 2008, 18(11): 14921494.
  10. 10. Lee WJ, Ser KH, Chong K, et al. Laparoscopic sleeve gastrectomy for diabetes treatment in nonmorbidly obese patients: efficacy and change of insulin secretion [J]. Surgery, 2010, 147(5): 664669.
  11. 11. GillRandall RJ, Adams D, Ollerton RL, et al. Is human Type 2 diabetes maternally inherited? Insights from an animal model [J]. Diabet Med, 2004, 21(7): 759762.
  12. 12. GillRandall R, Adams D, Ollerton RL, et al. Type 2 diabetes mellitus-genes or intrauterine environment? An embryo transfer paradigm in rats [J]. Diabetologia, 2004, 47(8): 13541359.
  13. 13. de Bona Castelan J, Bettiol J, d’Acampora AJ, et al. Sleeve gastrectomy model in Wistar rats [J]. Obes Surg, 2007, 17(7): 957961.
  14. 14. 鄧治洲, 王烈, 林憶陽(yáng), 等. 胃轉(zhuǎn)流術(shù)對(duì)非肥胖型2型糖尿病的療效觀察及其對(duì)胰高血糖素樣肽1的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2009, 16(6): 466469.
  15. 15. Patriti A, Facchiano E, Sanna A, et al. The enteroinsular axis and the recovery from type 2 diabetes after bariatric surgery [J]. Obes Surg, 2004, 14(6): 840848.
  16. 16. Purnell JQ, Flum DR. Bariatric surgery and diabetes: who should be offered the option of remission? [J]. JAMA, 2009, 301(15): 15931595.
  17. 17. Polyzogopoulou EV, Kalfarentzos F, Vagenakis AG, et al. Restoration of euglycemia and normal acute insulin response to glucose in obese subjects with type 2 diabetes following bariatric surgery [J]. Diabetes, 2003, 52(5): 10981103.
  18. 18. Vetter ML, Cardillo S, Rickels MR, et al. Narrative review: effect of bariatric surgery on type 2 diabetes mellitus [J]. Ann Intern Med, 2009, 150(2): 94103.
  19. 19. Rizzello M, Abbatini F, Casella G, et al. Early postoperative insulinresistance changes after sleeve gastrectomy [J]. Obes Surg, 2010, 20(1): 5055.
  20. 20. Cummings DE, Overduin J. Gastrointestinal regulation of food intake [J]. J Clin Invest, 2007, 117(1): 1323.
  21. 21. Cummings DE, Shannon MH. Roles for ghrelin in the regulation of appetite and body weight [J]. Arch Surg, 2003, 138(4): 389396.
  22. 22. Kageyama H, Funahashi H, Hirayama M, et al. Morphological analysis of ghrelin and its receptor distribution in the rat pancreas [J]. Regul Pept, 2005, 126(12): 6771.
  23. 23. Dezaki K, Kakei M, Yada T. Ghrelin uses Galphai2 and activates voltagedependent K+ channels to attenuate glucoseinduced Ca2+ signaling and insulin release in islet betacells: novel signal transduction of ghrelin [J]. Diabetes, 2007, 56(9): 23192327.
  24. 24. Pykk SM, Kellokoski E, Hrkk S, et al. Low plasma ghrelin is associated with insulin resistance, hypertension, and the prevalence of type 2 diabetes [J]. Diabetes, 2003, 52(10): 25462553.
  25. 25. Nslund E, Kral JG. Impact of gastric bypass surgery on gut hormones and glucose homeostasis in type 2 diabetes [J]. Diabetes, 2006, 55(Supplement 2): S92S97.
  26. 26. D’Alessio DA, Vahl TP. Glucagonlike peptide 1: evolution of an incretin into a treatment for diabetes [J]. Am J Physiol Endocrinol Metab, 2004, 286(6): E882E890.
  27. 27. Li Y, Cao X, Li LX, et al. BetaCell Pdx1 expression is essential for the glucoregulatory, proliferative, and cytoprotective actions of glucagonlike peptide1 [J]. Diabetes, 2005, 54(2): 482491.
  28. 28. Berthoud HR. Paying the price for eating ice cream: is excessive GLP1 signaling in the brain the culprit? [J]. Endocrinology, 2008, 149(10): 47654767.
  29. 29. Baggio LL, Drucker DJ. Biology of incretins: GLP1 and GIP [J]. Gastroenterology, 2007, 132(6): 21312157.
  30. 30. 賈乾斌, 汪靜, 趙紀(jì)春, 等. 胰升血糖素樣肽1對(duì)肝切除術(shù)后葡萄糖耐量的影響 [J]. 中國(guó)普外基礎(chǔ)與臨床雜志, 2001, 8(4): 215217.
  31. 31. Micic D, Duntas L, Cvijovic G, et al. Ghrelin and the enteroinsular axis in healthy men [J]. Hormones (Athens), 2007, 6(4): 321326.