25羟维生素D3及T淋巴细胞亚群变化与成人隐匿性自身免疫性糖尿病患者胰岛功能的关系

The relationships of 25(OH)D3,the changes of T lymphocyte subsets with islet function in patients with latent autoimmune diabetes in adults

目的:观察不同滴度谷氨酸脱羧酶抗体(GADA)成人隐匿性自身免疫性糖尿病(LADA)患者25羟维生素D3[25(OH)D3]水平及T淋巴细胞亚群的变化,探讨其与胰岛β细胞功能的关系。方法:在成人糖尿病(DM)患者中筛查获得GADA阳性患者,根据GADA滴度水平分为低滴度组和高滴度组,对照组为普通2型糖尿病(T2DM)患者。检测空腹血糖(FBG)、血脂、肝肾功能,糖化血红蛋白(HbA1c)、空腹血清C肽(FCP)、25(OH)D3和T淋巴细胞亚群(CD3^(+)、CD4^(+)和CD8^(+))。计算胰岛素抵抗指数[Homa-IR(CP)]和胰岛功能指数[Homa-islet(CP)]。结果:与T2DM组比较,高滴度组体重指数(BMI)、25(OH)D3水平、FCP、餐后2 h C肽(2 hCP)、Homa-IR(CP)和Homa-islet(CP)均降低,差异有统计学意义(P<0.05),同时合并有较低的总胆固醇(TC)、三酰甘油(TG)、尿酸(UA)水平,差异有统计学意义(P<0.05);低滴度组也表现出BMI、25(OH)D3水平、FCP、2 hCP、Homa-IR(CP)和Homa-islet(CP)降低,伴低TC水平,差异有统计学意义(P<0.05)。高滴度组CD4^(+)/CD8^(+)T比值高于低滴度组,差异有统计学意义(P<0.05),LADA患者CD4^(+)/CD8^(+)比值与GADA滴度呈正相关(r=0.37,P<0.01),25(OH)D3水平与Homa-islet(CP)呈正相关(r=0.32,P=0.02)。结论:低25(OH)D3水平及T淋巴细胞亚群比例失衡与胰岛β细胞功能损伤有关并参与LADA病程的进展。

Objective To study the changes of 25 hydroxyvitamin D3[25(OH)D3]levels and T lymphocyte subsets in patients with latent autoimmune diabetes in adults(LADA)according to different titers of glutamic acid decarboxylase antibody(GADA),and to explore the relationships between them and pancreatic isletsβCell function.Method According to GADA titer,adult diabetes mellitus(DM)patients with positive glutamate decarboxylase antibody(GADA)were diagnosed and divided into low and high titer group,and the control group was ordinary type 2 diabetes mellitus(T2DM).Fasting blood glucose(FBG),blood lipids,liver and kidney functions,glycosylated hemoglobin(HbA1c),fasting serum C-peptide(FCP),25(OH)D3 and T lymphocyte subsets(CD3^(+),CD4^(+)and CD8^(+))were measured in all subjects.Insulin resistance index[Homa-IR(CP)]and islet function index[Homa-islet(CP)]were calculated according to FBG and fasting C-peptide(FCP).Results Compared with the T2DM group,high-titers LADA patients had lower body mass index(BMI),25(OH)D3 level,higher CD4^(+)/CD8^(+)ratio,lower Homa-IR(CP)and Homa-islet(CP),worse fasting and postprandial C peptide levels,and accompanied lower levels of total cholesterol(TC),triglyceride(TG)and uric acid(UA)(P<0.05);Low-titers LADA patients also had lower BMI,25(OH)D3 level,lower Homa-IR(CP)and Homa-islet(CP),worse fasting and postprandial C peptide levels,and accompanied lower TC level(P<0.05).The CD4^(+)/CD8^(+)T ratio in the high titer group was higher than that in the low titer group(P<0.05).The CD4^(+)/CD8^(+)ratio in LADA patients was positively correlated with GADA titer(r=0.37,P<0.01),and 25(OH)D3 showed a positive correlation to Homa-islet(CP)(r=0.32,P=0.02).Conclusion Low 25(OH)D3 level and imbalance of T lymphocyte subsets are involved with isletβcell function impairment and may play an important role in LADA.