糖尿病合并肺部感染患者血清APN和TLR4表达及其与T淋巴细胞亚群的关系

Expression of serum APN,TLR4 and their relationship with T lymphocyte subsets in patients with diabetes mellitus complicated with pulmonary infection

目的探讨糖尿病合并肺部感染患者血清脂联素(APN)、Toll样受体4(TLR4)表达及其与T淋巴细胞亚群的关系。方法选择应急总医院2018年1月-2020年6月收治的100例糖尿病合并肺部感染患者作为感染组,选择同期接诊的单纯糖尿病患者100例为未感染组,并纳入同期于本院接受体检的80名健康人作为对照组。比较三组受试者血清APN、TLR4水平及T淋巴细胞亚群CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+),并分析血清APN、TLR4与CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)的相关性。结果感染组血清APN为(2.38±0.75)mg/L,明显低于未感染组的(4.50±1.31)mg/L和对照组的(7.84±1.49)mg/L,且未感染组低于对照组,差异均有统计学意义(P均<0.05);感染组血清TLR4为(4.75±1.39)ng/mL,明显高于未感染组的(2.04±0.67)ng/mL和对照组的(0.75±0.20)ng/mL,且未感染组高于对照组,差异均有统计学意义(P均<0.05)。感染组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)分别为(59.73±6.85)%、(26.86±3.27)%、(1.18±0.23),均低于未感染组的(66.12±5.74)%、(33.50±3.89)%、(1.32±0.19)和对照组的(78.02±6.12)%、(40.91±4.52)%、(1.54±0.27),且未感染组均低于对照组,差异均有统计学意义(P均<0.05)。经Pearson相关性分析显示,APN与CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均成正相关(r=0.378、0.420、0.359,P均<0.05),TLR4与CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均成负相关(r=-0.412、-0.395、-0.406,P均<0.05)。结论糖尿病合并肺部感染患者血清APN降低,TLR4升高,且与T淋巴细胞亚群存在相关性,临床上应予以密切关注。

Objective To investigate the relationship between serum adiponectin(APN),Toll-like receptor 4(TLR4)expression and their relationship with T lymphocyte subsets in patients with diabetes mellitus complicated with pulmonary infection.Methods A total of 100 patients with diabetes complicated with lung infection admitted to Emergency General Hospital from January 2018 to June 2020 were selected as infected group,100 patients with diabetes alone admitted in the same period were selected as uninfected group,and 80 healthy people who received physical examination in Emergency General Hospital during the same period were included as control group.The serum APN and TLR4 levels and T lymphocyte subsets CD3^(+),CD4^(+),CD4^(+)/CD8^(+)were compared among the three groups,and the correlations between serum APN and TLR4 and CD3^(+),CD4^(+),CD4^(+)/CD8^(+)were analyzed.Results The serum APN level in the infected group was(2.38±0.75)mg/L,which was significantly lower than those of the uninfected group[(4.50±1.31)mg/L]and the control group[(7.84±1.49)mg/L],and the serum APN level of the uninfected group was also lower than that of the control group,with statistical significance(P all<0.05);the serum TLR4 level in the infected group was(4.75±1.39)ng/mL,which was significantly higher than those of the uninfected group[(2.04±0.67)ng/mL]and the control group[(0.75±0.20)ng/mL],and the serum TLR4 level of the uninfected group was also higher than that of the control group,with statistical significance(P all<0.05).The CD3^(+),CD4^(+),CD4^(+)/CD8^(+)cells in infection group were(59.73±6.85)%,(26.86±3.27)%and(1.18±0.23),respectively,which were lower than those of the uninfected group[(66.12±5.74)%,(33.50±3.89)%,(1.32±0.19)]and the control group[(78.02±6.12)%,(40.91±4.52)%,(1.54±0.27)],and the indexes in the uninfected group were lower than those of the control group,with statistical significance(P all<0.05).Pearson correlation analysis showed that APN level was positively correlated with the percentages of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)(r=0.378,0.420,0.359;P all<0.05);the TLR4 level was negatively correlated with the percentages of CD3^(+),CD4^(+),CD4^(+)/CD8^(+)(r=-0.412,-0.395,-0.406;P all<0.05).Conclusion The serum APN level was decreased and TLR4 level was increased in patients with diabetes mellitus complicated with pulmonary infection,and they were correlated with T lymphocyte subsets,which should be paid close attention in clinical practice.