食管空肠支架转流术治疗2型糖尿病的机制初探.pdf

　 军 杂 2012年9月1 日　第37卷　第9期 702 解放 医学 志　 食管空肠支架转流术治疗2型糖尿病的机制初探 付唆林，朱惠明，郑丽，王文军 [摘要]　目的　观察内镜下行食管空肠覆膜支架转流术对2型糖尿病(T2DM)模型犬的治疗效果并探讨其机制。 方法　肥胖症并T2DM模型Beagle犬5 只作为手术组，行内镜下食管空肠覆膜支架转流术；正常Beagle犬5 只作为对 照组，行胃镜观察和剖腹探查术。检测两组术前及术后4 、8 、12周空腹血糖(FPG)、空腹胰岛素(FINS)、静脉葡萄 糖试验(IVGTT)2h血糖、IVGTT-2h胰岛素等糖尿病相关指标，计算胰岛素抵抗指数(HOMA-IR)和胰岛β细胞功能 (HOMA- β) ，并检测抑胃肽(GIP)和胰高糖素样肽-1(GLP-1)等胃肠激素水平。结果　与手术前比较，手术组FPG 、 FINS 、IVGTT-2h血糖和IVGTT-2h胰岛素均于术后4周出现显著下降(P 0.01) ，至术后12周接近对照组水平(P 0.05) ；术 后4周HOMA-IR值明显下降，HOMA- β值显著升高(P 0.01) ，至术后12周均接近对照组水平(P 0.05) ；术后4周GIP显 著下降(P 0.01) ，GLP-1水平显著升高(P 0.05) ，至术后8周接近对照组水平(P 0.05)。结论　食管空肠覆膜支架转流术 治疗T2DM安全有效，其机制可能与胃肠激素的变化有关。 [关键词]　糖尿病，2型；胃转流术；胃肠激素类 [中图分类号]　R587.1 [文献标志码]　A [文章编号]　0577-7402(2012)09-0702-04 Mechanism for esophagus-jejunum stent bypass in the treatment of type 2 diabetes mellitus FU Suo-lin1 2 3 3 , ZHU Hui-ming , ZHENG Li , WANG Wen-jun 1Clinical Medical Postdoctoral R esearch Station, J inan University, Guangzhou 510632, China 2Department of Gastroenterology, Second Affiliated Hospital of J inan University, Shenzhen, Guangdong 518020, China 3Department of Gastroenterology, Third Affiliated Hospital of Nanchang University, Nanchang 330008, China [Abstract]　Objective　To observe the effect of endoscopic esophagus-jejunum covered stent bypass on the treatment of type 2 diabetes mellitus (T2DM), and analyze the mechanism thereof. M ethods　Five obese Beagle dog models of T2DM underwent endoscopic esophagus-jejunum covered stent bypass to serve as operation group, and five normal Beagle dogs as control group receive endoscopy and exploratory laparotomy. The T2DM indices of both groups, including fast plasma glucose (FPG) level, fast insulin (FINS) level, intravenous glucose tolerance test-2h plasma glucose (IVGTT-2h PG) and IVGTT-2h FINS, were determined regularly before operation and 4, 8 and 12 weeks afte