Effects Of Intestinal Bypass Surgery On Lipotoxicity And Its Hypoglycemic Mechanism In Type 2 Diabetic Rats

Objective:To study the effect of duodenal jejunal bypass on postoperative blood glucose in type 2 diabetic rats and its possible mechanism of lowering blood glucose,comparing duodenal jejunal bypass,simple biliary-pancreatic bypass,duodenum Effect of jejunal debridement on blood lipids and lipotoxicity in type 2 diabetic rats and the possible mechanism of surgical treatment of type 2 diabetes.Methods:1.One hundred SPF male Sprague Dawley rats were fed with high-sugar and high-fat diet for 8 weeks.Intraperitoneal injection of streptozotocin?40 mg/Kg?was used.Sixty adult rats with random blood glucose?16.7 mmol/L were randomly divided into 4 groups.In the group,duodenal jejunal bypass,simple biliary-pancreatic bypass,duodenal jejunal placement and sham operation?control group?were performed.2.Measure the fasting body weight,24h food intake,fasting blood glucose and 2h postprandial blood glucose,fasting triglyceride,cholesterol,free fatty acid and insulin levels in rats 1 week before operation,8 weeks after operation,24weeks after operation,and HOMA-IR and HOMA-IS were calculated.The 13C breath test was performed 10 weeks after surgery.3.Rats were sacrificed by cervical dislocation at 24 weeks postoperatively.Apoptosis of islet cells was detected by tunel assay and the apoptosis rate of islet cells was calculated.Results:1.Fasting blood glucose:There was no significant difference in fasting blood glucose between DJB group,NBPD group and DJE group at 1 week before operation,8 weeks after operation and 24 weeks after operation.2.After 8 weeks,postprandial blood glucose 16.8±3.2 mmol/L in DJB group and 25.6±3.3 mmol/L in sham operation group,the difference was statistically significant?p<0.05?,postprandial blood glucose 19.9±2.5 in NBPD group The difference between mmol/L and 25.6±3.3 mmol/L in sham-operated group was statistically significant?p<0.05?.There was no significant difference between DJE group and sham-operated group.At 24 weeks postoperatively,the postprandial blood glucose level in the DJB group was 16.3±4.0 mmol/L compared with 26.9±3.6 mmol/L in the sham group?p<0.05?;postprandial blood glucose in the NBPD group was 20.6±3.3 mmol/L.The difference between L and sham group was 26.9±3.6 mmol/L,and the difference was statistically significant?p<0.05?.There was no significant difference between DJE group and sham operation group.3.At 8 weeks after operation,fasting serum triglyceride in DJB group was0.778±0.182 mmol/L compared with sham operation group 1.155±0.185 mmol/L,the difference was statistically significant?p<0.05?,and NBPD group was 0.937±0.099 mmol Compared with sham operation group,1.155±0.185 mmol/L,the difference was statistically significant?p<0.05?.Compared with 1.35±0.185mmol/L of sham operation group,1.35±0.180 of fasting triglyceride in DJE group was different.Statistical significance.At 24 weeks after surgery,there was a statistically significant difference between 0.885±0.176 mmol/L in the DJB group and 1.465±0.268 mmol/L in the sham operation group?p<0.05?;1.043±0.182mmol/L in the NBPD group and 1.465 in the sham operation group.The difference was statistically significant?±0.268 mmol/L??p<0.05?.There was no significant difference between the DJE group and the sham operation group.4.At 8 weeks after operation,serum free fatty acids in the DJB group was260.5±23.7 mmol/L compared with 387.2±45.4 mmol/L in the sham operation group?p<0.05?;315.5±39.0 mmol/L in the NBPD group.Compared with the sham group 387.2±45.4 mmol/L,the difference was statistically significant?p<0.05?.There was no significant difference between the DJE group and the sham operation group.At 24 weeks after operation,serum free fatty acids were 247.9±39.3 mmol/L in the DJB group compared with 411.0±96.1 mmol/L in the sham group?p<0.05?;serum free fatty acids in the NBPD group were 324.6±35.8mmol/L.The difference between L and sham-operated group was 411.0±96.1mmol/L,and the difference was statistically significant?p<0.05?.There was no significant difference between DJE group and sham-operated group.5.At 8 weeks after operation,the serum insulin in the DJB group was 0.290±0.031 ng/ml compared with the sham operation group 0.348±0.041 ng/ml,the difference was statistically significant?p<0.05?,and the NBPD group was 0.303±0.019 ng/ml.Compared with the sham operation group of 0.348±0.041 ng/ml,the difference was statistically significant?p<0.05?.There was no significant difference between the DJE group and the sham operation group.At 24 weeks after surgery,the serum insulin in the DJB group was 0.288±0.026 ng/ml compared with the sham group 0.377±0.028 ng/ml,the difference was statistically significant?p<0.05?;the serum insulin in the NBPD group was 0.318±0.023 ng/ml.Compared with the sham operation group,the difference was statistically significant?p<0.05?,and there was no significant difference between the DJE group and the sham operation group?0.377±0.028 ng/ml?.6.At 8 weeks after operation,there was a statistically significant difference in the DJB group's HOMA-IR 1.772±0.190 compared with 2.307±0.292 in the sham group?p<0.05?,1.829±0.112 in the NBPD group and the sham group.Compared with 2.307±0.292,the difference was statistically significant?p<0.05?.There was no significant difference between DJE group and sham operation group.At 24 weeks after surgery,the DJB insulin resistance index was 1.712±0.157compared with 2.307±0.292 in the sham operation group.The difference was statistically significant?p<0.05?;the insulin resistance index was 2.040±0.148 in the NBPD group and 2.307±0.292 in the sham operation group.The difference was statistically significant?p<0.05?.There was no significant difference between the DJE group and the sham operation group.7.At 8 weeks postoperatively,the difference in insulin sensitivity index?HOMA-IS?between the DJB group?0.568±0.059?and the sham operation group?0.474±0.053?was statistically significant?p<0.05?,while that of the NBPD group was 0.549±0.033 and that of the sham group.Compared with 0.474±0.053,the difference was statistically significant?p<0.05?.There was no significant difference between DJE group and sham operation group.At 24 weeks after surgery,the insulin resistance index of the DJB group was 0.589±0.060 compared with the sham operation group of 0.439±0.056,and the difference was statistically significant?p<0.05?.There was no significant difference between the NBPD group and the sham operation group?p<0.05?,there was no significant difference between the DJE group and the sham group.8.The apoptotic rate of islet cells in DJB group was 0.314±0.076 compared with sham group 0.408±0.053,the difference was statistically significant?p<0.05?.The apoptotic rate of 0.339±0.072 islet cells in NBPD group was compared with sham operation group 0.408±0.053.There was a statistically significant difference?p<0.05?.There was no significant difference between the DIE group and the sham group.9.¹³C caprylic acid DOB value:DJB group 8.9±2.7 less than the sham group 23.5±5.0,the difference was statistically significant,NBPD group 9.6±2.2 is smaller than the sham group,the difference was statistically significant,DJE group 25.4±2.6 and false There was no significant difference in the surgical group.Conclusion:Intestinal bypass surgery and simple biliary and pancreatic bypass can reduce blood lipid levels in type 2 diabetic rats,improve lipotoxicity,and no effect of intestinal fistula alone.Duodenal jejunal bypass mainly through the flow of biliary and pancreatic fluid,reduce the type 2 diabetes rats lipotoxicity,reduce islet cell apoptosis,improve insulin resistance,increase insulin sensitivity,produce hypoglycemic effect.