2型糖尿病患者T细胞亚群与血糖水平及胰岛素分泌的关系

Correlation of T Lymphocyte Subsets with Blood Glucose Level and the First-Phase Insulin Secretion in Patients with Type 2 Diabetes Mellitus

目的研究2型糖尿病患者T细胞亚群与血糖水平及早相胰岛素分泌之间的关系。方法以新诊断的78例2型糖尿病(DM)患者、60例葡萄糖耐量异常(IGT)患者和60名健康对照者(NC)为研究对象,分别给予口服葡萄糖耐量试验(OGTT)和胰岛素兴奋试验(IRT),检测糖化血红蛋白(HbA1c)、体重指数(BMI),流式细胞仪监测T细胞亚群(CD4+、CD8+)和自然杀伤(NK)细胞活性,采用葡萄糖负荷后30min的净增胰岛素与净增葡萄糖比值(⊿I30/⊿G30)评估早相胰岛素分泌功能。结果与NC组比较,IGT组和DM组患者的CD4+、CD4+/CD8+、NK细胞活性和⊿I30/⊿G30显著降低,HbA1c和CD8+显著升高(P<0.05或P<0.01);与IGT组相比,DM组患者的CD4+、NK细胞活性、⊿I30/⊿G30显著降低,空腹血糖(FBG)和HbA1c显著升高(P均<0.05),CD8+、CD4+/CD8+差异无统计学意义(P均>0.05)。CD4+与FBG(r=-0.213)和HbA1c(r=-0.386)呈显著负相关(P均<0.05),与⊿I30/⊿G30呈显著正相关(r=0.174,P<0.05)。逐步回归分析结果显示,CD4+与HbA1c和⊿I30/⊿G30独立相关。结论 2型糖尿病患者细胞免疫存在异常,T细胞亚群的紊乱与血糖升高和胰岛β细胞早相分泌功能缺陷有关。

Objective To explore the relationship between the T cell subsets and glucose level and first-phase insulin secretion function in patients with type 2 diabetes mellitus （T2DM）. Methods We deter- mined the oral glucose tolerance （ OGTT）, insulin release test （ IRT）, body mass index （ BMI）, glycohemo- globin Ale （HbAlc）, T lymphocyte subsets （CD4 ＋, CD8 ＋）, and activity of natural kill （NK） cell and △ I30/△ G3o in 78 newly diagnosed T2DM patients, 60 impaired glucose tolerance （IGT） patients, and 60 normal controls. Results DM and IGT patients had significantly lower levels of CD4 ＋ , CD4 ＋/CD8 ＋ ratio, activity of NK cell, and △I30/△ G3o and significantly higher levels of HbA1 c and CD8 ＋ compared with normal controls （ all P 〈 O. 05 ） . Patients in DM group had significantly lower level of CD4 ＋ , △I30/△G30 and sig- nificantly higher levels of FBG and HbA1 c compared with IGT group. There was no significant difference in terms of CD8 ＋ , CD4 ＋/CD8 ＋ ratio, and activity of NK cell between IGT and DM groups, whereas CD4 ＋ T cells were negatively correlated with FBG and HbAle and positively with △I3o/△G3o Multipul regressionstepwise analysis showed that CD4 ＋ was independently associated with HbA1 c and △ I30/△G30. Conclusion T2DM patients tends to have disorders in cellular immunity, which is correlated with blood glucose level and the insulin secretion function.