摘要:
目的 观察胃旁路术(Roux-en-Y,RYGB)后T2DM模型大鼠肩胛棕色脂肪组织(brown adipose tissue,BAT)形态、功能及特异表达解偶联蛋白(uncoupling protein,UCP1)改变,探索RYGB对T2DM模型大鼠BAT的影响及其相关机制,为RYGB治疗T2DM患者提供理论及实验依据.方法 SD大鼠经高脂高糖饲料喂养2周后,于大鼠腹腔内注射链脲佐菌素(streptozocin,STZ)30 mg/kg进行造模,72 h和1周后快速血糖仪测随机血糖,2次均≥16.7 mmol/L为成功造模,成模大鼠饲养环境:单笼饲养,标准大鼠饲料喂养,自然昼夜循环,室内温度(18±2)°C,室内湿度(50±2)%.动物分组:成模大鼠随机选取50只,以随机数字表法按干预方式分为糖尿病手术组(A组,n=10),行保留全胃的RYGB手术;糖尿病假手术组(B组,n=10),麻醉方法及切口同RYGB组,手术方式为胃前壁切开再缝合、空肠相应位置切断后原位吻合,缝合方法同糖尿病手术组;糖尿病对照组(C组,n=10),建立糖尿病造模成功后正常饲料喂养;健康对照组(D组,n=10),无特殊处理,保证充足饮水.其余大鼠备用.术前及术后第1、2、4、8周分别测各组大鼠体质量(body mass,BM)、空腹血糖(fasting plasma insulin,FPG)、空腹血清胰岛素(fasting plasma insulin,Fins).截面棕色脂肪细胞平均半径和细胞数目,利用IPP6.0图像分析软件辅助计算截面细胞数,进一步计算脂肪细胞平均半径;运用Western blot的方法进行检测UCP1表达.结果 ①糖尿病大鼠较健康对照组SD大鼠空腹血糖、空腹血清胰岛素水平及体质量增高,胰岛素敏感指数显著降低.②HE染色结果显示:糖尿病手术组(A组)大鼠较糖尿病对照组(C组)及糖尿病假手术组(B组)大鼠的截面细胞数及棕色脂肪平均半径明显增高,差异有统计学意义(P<0.01),糖尿病手术组(A组)大鼠与健康对照组(D组)大鼠,糖尿病对照组(C组)大鼠与假手术组(B组)大鼠间比较差异无统计学意义(P>0.05).③Western blot结果显示:胃旁路术后糖尿病手术组(A组)大鼠较糖尿病假手术组(B组)、糖尿病对照组(C组)大鼠肩胛棕色脂肪组织对UCP1表达显著增加(P<0.05),糖尿病假手术组(B组)与糖尿病对照组(C组)及糖尿病手术组(A组)与健康对照组(D组)之间比较差异无统计学意义(P>0.05).结论 RYGB能在降低糖尿病大鼠BM及胰岛素抵抗(insulin resistance,IR)的同时也促进大鼠肩胛BAT对UCP1的表达.RYGB可能通过调节UCP1信号通路的途径增加体内BAT活性实现改善机体IR.%Objective To observe what changes the brown adipose tissue (BAT) of T2DM rat models would have,including morphology,function and specially expressed uncoupling protein (UCP1) after the gastric bypass (Roux-en-Y,RYGB) and to explore the effects of RYGB on BAT of T2DM rat models and its related mechanism in order to provide a theoretical and experimental basis for treatment of T2DM patients with RYGB.Methods SD rats were given a high-fat and high-sugar diet for two weeks,by injecting streptozotocin (STZ) 30 mg/kg intraperitoneally to build models.Blood glucose was measured after 72 h and 1 week by the fast blood glucose meter.The models were built successfully if blood glucose at both times were ≥ 16.7 mmol/L.Feeding environment:individually caged,standard rat feed,natural circadian cycle,indoor temperature (18±2)°C,indoor humidity (50±2)%.50 rats were randomly selected and dividing into four groups according to intervention methods:diabetes operation group (group A,n=10),undergoing RYGB surgery with the whole stomach kept;diabetes sham operation group (group B,n=10),the same anesthesia and incision as the previous RYGB group.The operation mode was anterior gastric wall incision and suture,jejunum transection in corresponding position and in situ anastomosis with the same suture method as group A;diabetes control group (group C,n=10),normally feeding after building models;and the last one was the healthy control group (group D,n=10):no special treatment,adequate water feeding ensured.The rest of rats remained to be used.The body mass (BM),fasting blood glucose (FBG),fasting serum insulin(Fins)before and at the 1st,2nd,4th and 8th week after surgery were measured.The number of transversal ceils was calculated by IPP6.0 image software and the average radius of fat cells was calculated.UCP1 expression was tested with western blot.Results ① The fasting blood glucose,fasting serum insulin level and the body weight of dia betic rats were higher than those of the control group,but the insulin sensitivity index was significantly lower.② HE Staining showed:diabetes operation group (group A) rats,compared with diabetes control group and diabetes sham operation group(group B),had obviously higher brown fat cell counts transversally and average radius,and the difference was statistically significant (P<0.01).Diabetes operation group (group A) rats had no significant difference from the healthy control group(group D) rats,and the diabetes control group (group C) rats had no significant difference from sham operation group (group B) rats as well.③ Western blot showed that after the gastric bypass surgery,compared with the diabetes sham operation group (group B) and the diabetes control group (group C),UCP1 expression of brown adipose tissue of the diabetes operation group (group A) increased significantly (P<0.05).The diabetes sham operation group (group B) had no significant difference from the diabetes control group (group C),and the diabetes operation group(Group A) had no significant difference from the healthy control group (Group D) as well (P>0.05).Conclusion RYGB can reduce the body mass and insulin resistance (IR) of diabetic rats and,at the same time,promote the expression of UCP1 of brown adipose tissue.RYGB might increase the activity of brown adipose tissue by regulating the UCP1 signaling pathway to improve body's insulin resistance.