初诊2型糖尿病患者CD4^+CD25^+FoxP3^+调节性T细胞的变化和意义

Change and significance of CD4^+CD25^+FoxP3^+Treg in patients with type 2 diabetes before and after insulin intensive therapy

目的探讨CD4+CD25+FoxP3+调节性T细胞(Treg细胞)在2型糖尿病(T2DM)发生、发展中的作用。方法应用细胞膜打孔和三色荧光标记流式细胞术检测46例初诊T2DM患者胰岛素强化治疗前后的CD4+CD25+FoxP3+Treg细胞的比例,并分析其与细胞因子的相关性。结果胰岛素强化治疗3个月后,CD4+CD25+FoxP3+Treg细胞的比例和CD3+T、CD4+T细胞均较治疗前明显升高,C反应蛋白(C-RP)和肿瘤坏死因子α(TNF-α)水平较治疗前降低(P<0.05)。治疗前后CD4+CD25+FoxP3+Treg细胞的比例与CD3+、CD4+、TNF-α、白细胞介素6(IL-6)、胰岛素抵抗指数(HOMA-IR)、胰岛细胞功能指数(HOMA-β)均无明显相关性。治疗前,CD3+T细胞百分比与CD4+T细胞百分比、IL-6水平与HOMA-β成正相关(P<0.05)。治疗2周时,TNF-α与HOMA-IR和HOMA-β成正相关,而IL-6与C-RP成负相关(P<0.05)。结论初诊T2DM患者存在CD4+CD25+FoxP3+Treg细胞数量的紊乱,胰岛素强化治疗后CD4+CD25+FoxP3+Treg细胞较治疗前显著升高。低水平的Treg细胞一方面可能是T2DM发生发展的因素,另一方面可能是高血糖的结果 。

Objective To study the proportion of CD4^＋CD25^＋FoxP3^＋ regulatory T cell in patients with type 2 diabetes（T2DM） before and after insulin intensive therapy.Methods The propotion of CD4^＋CD25^＋FoxP3^＋ regulatory T cells was measured with flow cytometry in 46 T2DM cases before and after insulin intensive therapy and the relationship between that and other cytokines was analyzed.Results The propotion of CD4^＋CD25^＋FoxP3^＋ regulatory T cell and the amonts of CD3＋T and CD4＋T cells were significantly higher after treatment than those before（P0.05）.The levels of C-reactive protein（C-RP） and tumor necrosis factor-α（TNF-α） were significantly lower after treatment than those before（P0.05）.The proportion of CD4^＋CD25^＋FoxP3^＋ regulatory T cells was not significantly correlated with CD3＋,CD4＋,TNF-α,IL-6,HOMA-IR and HOMA-β.After 2 weeks of insulin treatment,the level of TNF-α was positively correlated with both HOMA-IR and HOMA-β（P0.05）,while IL-6 negatively correlated with C-RP（P0.05）.Conclusion The proportion of CD4^＋CD25^＋FoxP3^＋ regulatory T cells is increased in T2DM patients after insulin intensive therapy.Reduced level of Treg cells may be the result of hyperglycemia and a factor for the development and progress of T2DM as well.