Effects Of Metabolic Surgery On Serum Gastrointestinal Hormones And Fibroblast Growth Factors Levels In Type 2 Diabetes Mellitus Patients

Background: Type 2 diabetes mellitus(T2DM)is a kind of chronic disease,the traditional therapy is based on internal medicine management,but it is difficult to achieve the treatment goals and to avoid the side effects of drugs.To date,metabolic surgery,the only possible intervention for curing type 2 diabetes,is being gradually carried out in linical,more and more patients have got satisfactory weight loss and glycemic control.But it is fact that there are still part of patients with ineffective treatment or relapse after surgery,which is considered closely related to the unknown mechanism of metabolic surgery.The mechanism of metabolic surgery for T2DM is complex,gastrointestinal hormones such as glucagon-like peptide 1(GLP-1),peptide tyrosine tyrosine(PYY)and fibroblast growth factor 19(FGF19),fibroblast growth factor 21(FGF21)have received much attention.Objective: To quantify the changes of serum GLP-1,PYY,FGF19 and FGF21 levels in T2DM patients with obesity 3 month after laparoscopic bariatric surgery,and to investigate the possible mechanism of metabolic surgery preliminarily.Method: The ligible patients received laparoscopic metabolic surgery were divided into 2 groups according to the diagnosis,the patients in the research group were clearly diagnosed with T2DM,and the control group included simple obese patients with normal glucose metabolism.Clinical data were collected before and 3 months after operation,including medication situation,height(H),body weight(W),waist circumference(WC),fasting plasma glucose(FPG),fasting C peptide(FCP),glycosylated hemoglobin(HbA1c),total cholesterol(TC),triglyceride(TG),low density lipoprotein cholesterol(LDL-C),high density lipoprotein cholesterol(HDL-C),body mass index(BMI),homeostasis model assessment-insulin resistance index(HOMA-IR).Fasting blood serum was collected before operation and 3 months after operation to detect the concentration of GLP-1,PYY,FGF19,FGF21.Statistic method was used to compare the two groups of data before and 3 months after operation,to observe the efficacy of metabolic surgery,analysis the influences of metabolic surgery on serum GLP-1,PYY,FGF19,FGF21,and to investigate the correlation between GLP-1,PYY,FGF19,FGF21 level and associated clinical indexes of glucose and lipid metabolism.Result: 1.The level of W,WC,BMI,FPG,HbA1 c,FCP,HOMA-IR,TG decreased in the research group 3 months after operation(P<0.05);The level of W,WC,BMI,FCP,HOMA-IR decreased,while HDL-C increased in the control group after 3 months than that before operation(P<0.05).2.The efficacy of metabolic surgery on T2DM:The treatment was effective in 14cases(93.3%),and ineffective in 1 cases(7%)3 months after operation of research group,with no worsening case.The effective patients included 6 cases of remission(40%)and 8 cases of improvement(53.3%).Only 1 patients was still treated with oral hypoglycemic agents,and the other 13 patients(86.67%)were no need to use any hypoglycemic agent and insulin.3.The levels of PYY and FGF21 of the research group increased 3 months after operation,and the FGF19 was lower than that before operation(P<0.05),the level of GLP-1 showed a rising trend(P>0.05);The level of GLP-1 in the control group was higher,The level of FGF19 was lower than that before operation(P<0.05),the levels of PYY and FGF21 showed rising trends(P>0.05).4.In the study group,The level of PYY and W,WC,BMI,FPG were negatively correlated(r=-0.501,P=0.005;r=-0.549,P=0.002;r=-0.406,P=0.026;r=-0.456,P=0.011),the level of FGF19 and HbA1 c were positively correlated(r=0.451,P=0.012),the level of FGF21 and W,WC,BMI,FPG,HOMA-IR were negativelycorrelated(r=-0.514,P=0.004;r=-0.578,P=0.001;r=-0.448,P=0.013;r=-0.370,P=0.044;r=-0.386,P=0.035).In the control group,the level of GLP-1 and WC,FPG were negatively correlated(r=-0.735,P=0.038;r=-0.714,P=0.047),the level of FGF19 and TG were positively correlated(r=0.805,P=0.016),the level of FGF19 and HDL-C was negatively correlated(r=-0.857,P=0.016).Conclusion: 1.Laparoscopic metabolic surgery could effectively reduce body weight,improve insulin resistance and lipid metabolism in obese patients,and improve glucose metabolism in patients with T2DM.2.The serum levels of PYY and FGF21 increased,the level of FGF19 decreased after 3 months of metabolic surgery.3.PYY,FGF19 and FGF21 might be involved in the hypoglycemic mechanism of metabolic surgery in obese patients with T2DM.