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目的 Roux-en-Y胃转流术(RYGB)对2型糖尿病胰岛素抵抗的影响及其骨骼肌脂肪酸氧化的变化。方法观察糖尿病GK大鼠(糖尿病组)、行RYGB的糖尿病GK大鼠(RYGB干预组)和正常Wistar大鼠(正常对照组)的体质量、空腹血糖、空腹胰岛素、胰岛素抵抗指数、游离脂肪酸和骨骼肌脂肪酸氧化率的变化情况,大鼠骨骼肌用枸橼酸铅电子染色,透射电子显微镜下观察3组大鼠骨骼肌微结构和线粒体的改变。结果与糖尿病组相比,RYGB干预组血清游离脂肪酸浓度有下降的趋势,骨骼肌脂肪酸氧化率增加,体质量、空腹血糖、空腹胰岛素和胰岛素抵抗指数的改善均较明显(P<0.05)。RYGB干预组、糖尿病组和正常对照组的骨骼肌脂肪酸氧化率分别为(4.75±1.03)%、(1.9±0.27)%和(2.67±0.53)%。糖尿病组与正常对照组比较以及RYGB干预组与糖尿病组比较差异均有统计学意义(P<0.05)。与正常对照组大鼠比较,糖尿病组的骨骼肌组织肌丝结构紊乱,形成溶解性空泡,线粒体数量减少,明显肿胀,可见坏死呈空泡状的局部变性;RYGB干预组与糖尿病组比较,骨骼肌组织肌节结构排列和线粒体数量均有明显改善。结论 RYGB可通过减少血清游离脂肪酸和保护骨骼肌脂肪酸氧化功能改善糖尿病大鼠的胰岛素抵抗。
Objective To investigate the effect of Roux-en-Y gastric bypass (RYGB) on insulin resistance and the fatty acid oxidation of skeletal muscle in type 2 diabetic patients. Methods The body weight, fasting blood glucose, fasting insulin, insulin resistance index, free fatty acid and insulin resistance in diabetic GK rats (diabetic group), RYGB diabetic GK rats (RYGB intervention group) and normal Wistar rats (normal control group) Skeletal muscle fatty acid oxidation rate changes, rat skeletal muscle lead citrate staining, transmission electron microscopy of skeletal muscle microstructure and mitochondrial changes in three groups of rats. Results Compared with diabetic group, serum free fatty acid concentration in RYGB group tended to decrease, fatty acid oxidation rate in skeletal muscle increased, body weight, fasting blood glucose, fasting insulin and insulin resistance index improved significantly (P <0.05). The fatty acid oxidation rates of skeletal muscle were (4.75 ± 1.03)%, (1.9 ± 0.27)% and (2.67 ± 0.53)%, respectively in RYGB intervention group, diabetic group and normal control group. There was significant difference between diabetic group and normal control group and RYGB intervention group and diabetic group (P <0.05). Compared with the normal control group, the myofilament structure of skeletal muscle tissue of diabetic group was disordered and dissolved vacuolus was formed, the number of mitochondria was decreased, the swelling was obvious, and the local degeneration of vacuolar vesicular necrosis was observed. Compared with diabetic group, Skeletal muscle tissue structure and mitochondrial arrangement of mitochondrial number were significantly improved. Conclusion RYGB can improve insulin resistance of diabetic rats by decreasing serum free fatty acid and protecting fatty acid oxidation of skeletal muscle.