The Clinic And Basic Reasch Of Obesity Surgery For Type2Diabetes Mellitus In Chinese Patienes

Part I:The clinical effectiveness and safety of Laparoscopic gastrointestinal surgery in the treatment of type2diabetesObjective:To discuss the clinical effectiveness and safety of laparoscopic gastric bypass (LRYGBP) and laparoscopic sleeve gastrectomy with duodeno-jejunal bypass (LSG+DJB) in surgerical treatment of type2diabetes.Methods:To retrospective analysis the data of78patients with type2diabetes mellitus who got laparoscopic minimally invasive surgerical treatment in the first hospital affiliated to Soochow University from May2010to March2013, compared with internal hospitalize drug treatment of85cases in the same period, clinical data of patients, such as the length of hospital stay, operative time, blood loss, surgical operation related complications were recorded. All patients were subjected to follow-up controls with anthropometric and metabolic indices,such as weight, body mass index (BMI), waist circumference, fasting plasma glucose and oral glucose tolerance test (OGTT), HbAlc, blood lipids and the change of diabetes complications, etc.at1,3,6and12months after surgery.Results:1. All the patients were discharged smoothly after surgery without perioperative death and surgery related complications were:9.0%(7/78)(LRYGB) and10.0%(1/10)(LSG+DJB). The FBG, HbAlc, weight, BMI, waist circumference, serum triglyceride, cholesterol, low density lipoprotein cholesterol (LDL-C) of the patients were declined significantly and rapidly after the operation compared with preoperative. 2.70.5%of patients with type2diabetes got remission after the surgery one year later and25.6%of the patients got condition improved. Whereas in the group of internal medications no patient can stop any anti-diabetes drugs and cure type2diabetes,85.9%of patients got improvement.3. A year after the surgery, the remission rate of type2diabetes by LRYGB and LSG+DJB two different surgical treatment is66.6%and80%, respectively.Conclusions:1. LRYGB and LSG+DJB, two kinds of laparoscopic gastrointestinal surgery can be performed safely in obese or non-obese patients with type2diabetes without severe complications; The effect is better in obese patients than in non-obese patients.2. LRYGB and LSG+DJB, these two kinds of laparoscopic gastrointestinal surgery can effectively reduce the weight, control blood glucose and lipid levels in the patients with type2diabetes and complications related to diabetes. The long-term effect remains to be expected.Part II:Gastrointestinal hormone changes after the laparoscopic gastrointestinal surgery in the treatment of type2diabetesObjective:To discuss the changes of a series of gastrointestinal hormones such as GLP-1, Ghrelin, Leptin, after the surgeries and the mechanism in the surgical treatment of type2diabetes.Methods:ELISA method to detect the changes of the serum glucose-dependent insulinotropic peptide (GIP), Glucagon like peptide1(GLP-1), Glucagon like peptide-2(GLP-2), Ghrelin, Cholecystokinin (CCK), Amylin, Gastrin, Pancretic polypeptide(PP), PYY3-36, Oxyntomodulin(OMX), Secretin, Motilin(MTL), Leptin and ADP in patients with type2diabetes got treatment by laparoscopic gastrointestinal surgery before surgery and3,6,12 months after surgery.Results:1. GIP, PYY, Amylin, MTL, LEP level in serum changed dramatically in patients with type2diabetes after LRYGB.2. Ghrelin, GLP-1levels in serum have no significant change expected in patients with type2diabetes after LRYGB.Conclusions:1. Gastrointestinal hormone appeared significant change in patients with type2diabetes after Bariatric/Metabolic surgery. Gastrointestinal hormone plays a major role in diabetes remission postoperative.2There is great difference of changes in gastrointestinal hormone after Bariatric/Metabolic surgery and it is not determined by the single factor announced for the weight loss and glycemic control after the surgery.PartⅢ:serum MicroRNAs changes after the laparoscopic gastrointestinal surgery in the treatment of type2diabetes and its role of prediction and evaluation in the surgical therapeutic effectObjective:To discuss the miRNA-375and other diabetes associated miRNAs changes in surgical treatment of type2diabetes and the miRNA-375as a role of prediction and evaluation of effect in the surgery.Methods:qRT-PCR method to detect the changes of miR-375, miR-9, miR-29a, miR-30d, miR-122a, miR-124a-1in the serum of the patients with type2diabetes before surgery and1,3and6months after laparoscopic gastrointestinal surgery.Results:1. miR-375、miR-9、miR-122a、miR-124a-1level in serum changed dramatically in patients with type2diabetes after LRYGB.2. The variations of the miR-375levels in serum correlated with the improvement of pancreatic islet function. The change of the miR-122a level have correlation with the improvement of blood lipid.Conclusions:microrRNA-375and other diabetic microRNAs in serum can be dectected in the clinic as new biomarkers served as an effective auxiliary role of evaluation of the islet function and prediction in the surgical therapeutic effect.