外周血白细胞计数、T细胞亚群、肿瘤坏死因子-α与2型糖尿病胰岛素抵抗的相关性研究

Relevance of peripheral white blood cell,T lymphocyte subsets,tumor necrosis factor-alpha and insulin resistance in type 2 diabetes mellitus

目的探讨外周血白细胞计数、T细胞亚群、肿瘤坏死因子-α(TNF-α)与2型糖尿病胰岛素抵抗(IR)的相关性.方法分析76例2型糖尿病(DM)患者[按体质量指数分为非肥胖组(DM1)、肥胖(DM2)组,各38例]和30例正常对照组(NC)的WBC、T细胞亚群、TNF-α和空腹血糖、空腹胰岛素(INS)水平.结果①DM1组和DM2组比对照组WBC(6.15±1.29)×109/L、(6.68±1.34)×109/vs(5.51±1.48)×109/L,TNF-α水平(23.79±4.48)nmol/L,(27.90±5.52)nmo1/Lvs(22.07±3.70)nmol/L明显升高(P＜0.05～0.01),且DM2组的WBC、TNF-α水平高于DM1组;②DM1组和DM2组的CD4+(22.83±1.57)%、(27.4±2.12)%,CD8+(28.64±5.29)%、(27.35±6.14)%比NC组(22.30±1.90)%和(35.71±6.07)%明显升高;但CD4+/CD8+在3组之间差别无统计学意义;③根据稳态模式HOMA-IR=FBG×FINS/22.5公式计算各组HOMA-IR,取其中位数,可见NC组的IR为1.76±0.67,DM1组的IR为4.85±0.89,DM2组的IR为5.23±0.75.Spearman相关分析显示,HOMA-IR与WBC(r=0.208,P＜0.05)、TNF-α(r=0.316,P＜0.01)、CD4+/CD8+(r=0.1985)呈正相关,但是与CD4+、CD8+负相关(r=-0.1162,r=-0.2618,P＜0.05).结论2型糖尿病患者外周血WBC、T细胞亚群、TNF-α与IR相关.

Objective To analyze the relevance of peripheral white blood cell（WBC）,T lymphocyte subsets, tumor necrosis factor-alpha（TNF-α） and insulin resistance（IR） in type 2 diabetes mellitus（T2DM）. Methods WBC,T lymphocyte subsets,TNF-α, fasting plasma glucose（FPG） and fasting insulin（FINS） were analyzed in 76 eases of T2DM（According to body mass index,38 non-obesity objects named DM1 group and 38 obesity objects named DM2 group） and 30 normal controls （NC group）. The HOMA-IR was applied to assess the status of IR. Results ① Compared with NC group, WBC of DM1 group and DM1 group was （6.15±1.29）×10^9/L, （6.68±1.34）×10^9/L vs （5.51± 1.48） × 10^9/L; TNF-a of DM1 group and DM2 group was （23.79± 4.45） nmol/L, （27.90±5.52） nmol/L vs （22.07±3.70） nmol/L（ P 〈0.05-0.01） ②By contrast to NC group,CD^4＋ and CD^8＋ T lymphoeytes were decreased drastically in both DM1 and DM2 groups,CD^4＋ （22.83±1.57）%, （27.4±2.12）% vs （46.26± 8.53）% （ P 〈0.05）, CD^8＋ （28.64±5.29）%, （27.35± 6.14）% vs （22.30 ± 1.90）% （ P 〈0. 01）, but CD^4＋/CD^8＋ showed no significant difference anmong the three groups;③According to the HOMA-IR, the mean of HOMA-IR in NC group was 1.76±0.67, while the mean in DM1 group was 4.85 ±0.89, the mean in DM2 was 5.23±0. 753 Spearman correlation analysis showed that HOMA-IR was positively correlated to WBC（ r = 0. 2078, P 〈0.05）,TNF-α（ r = 0. 3162, P 〈0.01） and CD^4＋/CD^8＋（r =0.1985, P 〈0.005）,but was negatively correlated to CD^4＋ and CD^8＋ （r = -0.1162, r = -0. 2618, P 〈0.05）. Conclusion Peripheral WBC,T lymphocyte subsets,TNF-α were correlated to IR in T2DM.