2型糖尿病下肢血管病变气阴两虚兼血瘀证患者细胞免疫状态观察

Observing the Cell Immunityr State of Type 2 Diabetes Mellimus(T2DM) Patients Complicating Limb Vessel Pathological Changes

目的:观察2型糖尿病下肢血管病变气阴两虚兼血瘀证不同证候积分患者细胞免疫状态并分析其与多重血管危险因素的相关性。方法:根据中医证候积分分级标准,将符合纳入标准的74例患者分为轻、中、重3组,另设10例健康志愿者为对照组,观察各组患者年龄、诊断糖尿病时间、体质指数、血脂、糖化血红蛋白(HbA1c)、胰岛素抵抗指数(HOMA-IR)、稳态模型胰岛B细胞功能指数(HBCI)、超敏C反应蛋白(Hs-CRP)、纤维蛋白原(Fbg)、游离脂肪酸(FFA)、CD4、CD4%、CD8、CD8%、CD4/CD8的变化情况并行多元回归分析CD4、CD8与上述因素的相关性。结果:轻、重组间年龄、HOMA-IR、TG、FFA间比较其差异有统计学意义(P<0.05),轻、重组间及中、重组间诊断糖尿病时间、HbA1c、LDL-c、Fbg方面比较其差异有统计学意义(P<0.05),轻、中、重3组中TG、HDL-c、LDL-c、CD4、CD8分别与健康对照组比较其差异均有统计学意义(P<0.05)。轻、中、重3组间Hs-CRP、CD4、CD8、CD4%比较其差异均有统计学意义(P<0.05);轻、重组间CD8%比较及中度组与重度组CD8%比较其差异有统计学意义(P<0.05);中度组与轻度组及重、轻组间CD4/CD8比较其差异有统计学意义(P<0.05)。CD4与诊断DM时间、HbA1c、LDL-c、HOMA-IR、Hs-CRP呈负相关(P<0.05),CD8与HbA1c、HOMA-IR、TG、LDL-c、Hs-CRP、Fbg、FFA呈正相关(P<0.05)。结论:①2型糖尿病下肢血管病变气阴两虚兼血瘀证患者存在不同的T淋巴细胞分化及分泌细胞因子的改变,②2型糖尿病史的进展及迁延、高糖毒性、脂毒性、胰岛素抵抗等内分泌代谢因素及炎症反应机制的参与可能是该类患者机体细胞免疫状态紊乱的重要病理生理。

Objective：To observe the cell immunityr state and to analyze the correlations among muhiplicitas risk factors to hmb vessel pathological changes of type 2 diabetes melhmus （T2DM） and the syndrome of qi and yin deficient and stagnation of blood（SQYDSB） patients. Methods：According to the standard of traditional chinese medicial （TCM） symp- tom accumulated points, we grouped seventy four T2DM complicating LVP patients into light, middle and heavy class. In addition, we established ten health volunteers for the controled group. Observing the changes of age, course of diseases, BMI, lipoproteinemia, HbAlc, HOMA- IR, HBCI, Hs- CRP, fibrinogen, FFA, CIM, CIM%, CD8, CD8% and CIM/CD8. Results：The differences of course of diseases, HOMA - IR, TG and FFA are significant between light and heavy groups（P 〈 0.05）. For light and heavy groups and middle and heavy groups, the differences of course of diseases, HbA1 c, LDL - c, fibrinngen are significant（ P 〈 0.05 ）. Among light, middle and heavy groups, TG, HDL - c, EDL - c, CIM and CD8 are obvious differences than the controled group＇s （P 〈 0.05）. The differences of Hs -CRP, CD4, CDS and CIM% are significant among light, middle and heavy groups. Between light and heavy groups, the difference of CD8% is significant （P 〈0.05）. The difference of CI）8% is also between middle and heavy groups. We find, on the one hand, the negative correlation is significant for CD4 correlating with course of diseases, HbAlc, LDL - c, HOMA -IR, Hs- CRP （P 〈 0. 05 ）. On the other hand the positive correlation is significant for CD8 correlating with HbAlc, HOMA - IR, TG, LDL - c, Hs - CRP, Fbg and FFA. Conclusion ： There are different states to T lymphocyte differentiation and secreting cytokines for SQYDSB T2DM complicating LVP patients. It is possible important pathological and phys iological mechanism for the state s to advancing course of T2DM diseases, high glucose toxicity, adip - toxicity, IR, endocrine secretion and inflammatory reaction.