• 1.華西醫(yī)科大學(xué)附屬第一醫(yī)院普外科(成都610041);;
  • 2.進(jìn)修生，現(xiàn)在貴州省關(guān)嶺縣醫(yī)院外科（關(guān)嶺561300）;;
  • 3.華西醫(yī)科大學(xué)附屬第一醫(yī)院放免中心;

目的  探討胰升血糖素樣肽-1（GLP-1）對(duì)肝切除術(shù)后應(yīng)激性糖代謝紊亂的影響。
方法  將大鼠隨機(jī)分3組。Ⅰ組又分Ⅰg組，注射50%葡萄糖（0.5 g/kg體重）+生理鹽水； Ⅰglp組，注射50%葡萄糖+GLP-1（0.3 nmol/kg體重）行葡萄糖耐量實(shí)驗(yàn)。Ⅱ組切肝約65%后分Ⅱg和Ⅱglp組，分別于術(shù)后第1、3、5天 按Ⅰ組方法分別行葡萄糖耐量實(shí)驗(yàn)。Ⅲ組切肝后第1天行葡萄糖耐量實(shí)驗(yàn)，GLP-1按0.45 nmol/kg體重給予。觀察峰值血糖、30分鐘血糖及曲線下面積（AUC0~30）。
結(jié)果  Ⅰglp組峰值血糖和30分鐘血糖及AUC0~30明顯低于Ⅰg組； Ⅱg組術(shù)后 1、3、5天峰值血糖和30分鐘血糖及AUC0~30均明顯高于Ⅰg組。Ⅱglp組術(shù)后第1天峰值血糖與Ⅱg組差異無顯著意義； 但Ⅲ組明顯低于Ⅱg組及Ⅱglp組，30分鐘血糖也明顯低于Ⅱg組，且AUC0~30也明顯低于Ⅱg組及Ⅱglp組； Ⅱglp組術(shù)后 3、5天峰值血糖、術(shù)后1天血糖值、30分鐘血糖及AUC0~30均明顯低于Ⅱg組，與Ⅰg組相似。
結(jié)論  肝切除術(shù)后機(jī)體對(duì)葡萄糖的耐量下降，輸注外源性GLP-1可促進(jìn)機(jī)體對(duì)葡萄糖的利用； 術(shù)后早期GLP-1促進(jìn)機(jī)體利用葡萄糖的作用明顯減弱，但增加GLP-1的劑量仍可改善機(jī)體對(duì)葡萄糖的利用； 隨著手術(shù)應(yīng)激程度減輕，GLP-1促進(jìn)機(jī)體利用葡萄糖能力增強(qiáng)，可達(dá)正常水平。

引用本文： 賈乾斌,汪靜,趙紀(jì)春,江萬春,李雙慶,吳言濤. 胰升血糖素樣肽-1對(duì)肝切除術(shù)后葡萄糖耐量的影響. 中國普外基礎(chǔ)與臨床雜志, 2001, 8(4): 215-217. doi: 復(fù)制

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  2. 2. Higgins GM, Anderson RM. Experimental pathology of the liver. I. Restoration of the liver of the white rat following partial surgical removal 〔Ｊ〕. Arch Pathol, 1931; 12∶186.
  3. 3. Mori K, Ozawa K, Yamamoto Y, et al. Response of hepatic mitochondrial redox state to oral glucose load 〔Ｊ〕. Ann Surg, 1990; 211(4)∶438.
  4. 4. 李曉武， 吳言濤. 應(yīng)激狀態(tài)下胰島素抵抗機(jī)理的探討〔Ｊ〕. 中華實(shí)驗(yàn)外科雜志， 1992； 9（增刊）∶61.
  5. 5. Hvidberg A, Nielsen MT, Hilsted J, et al. Effect of glucagonlike peptide1 (proglucagon 78-107 amide) on hepatic glucose production in healthy man 〔Ｊ〕. Metabolism, 1994; 43(1)∶104.
  6. 6. Miki H, Namba M, Nishimura T, et al. Glucagonlike peptide1 (7-36) amide enhances insulin stimulated glucose uptake and decreases intracellular cAMP content in isolated rat adipocytes 〔Ｊ〕. Biochim Biophys Acta, 1996; 1312(2)∶132.
  7. 7. VillanuevaPenacarrillo ML, Alcantara AI, Clemente F, et al. Potent glycogenic effect of GLP1 (7-36) amide in rat skeletal muscle 〔Ｊ〕. Diabetologia, 1994; 37(11)∶1163.
  8. 8. Ranganath L, Schaper F, Gama R, et al. Effect of glucagon on carbohydratemediated secretion of glucosedependent insulinotropic polypeptide (GIP) and glucagonlike peptide1 (7-36 amide) (GLP1) 〔Ｊ〕. Diabetes Metab Res Rev, 1999; 15(6)∶390.