糖尿病并发肺结核外周血可溶性Fas和可溶性FasL水平研究

目的探讨糖尿病并发肺结核患者外周血可溶性Fas（sFas）和可溶性FasL（sFasL）变化，以期为糖尿病并发肺结核的病情判断及干预治疗提供依据。方法选取糖尿病并发肺结核（糖尿病并发肺结核组）、单纯糖尿病（糖尿病组）、单纯肺结核（肺结核组）、健康体检者（对照组）各25例，以酶联免疫吸附试验法检测外周血sFas和sFasL及T淋巴细胞亚群水平。结果糖尿病并发肺结核组、糖尿病组、肺结核组外周血sFas及sFasL水平明显高于对照组[（7．91±1．93）、（8．74±2．12）、（7．86±1．61）mg／L比（2．10±0．88）mg／L和（562．37±196．38）、（1512．32±303．48）、（607．48±102．53）．g／L^E（263．18±46．32）ng／L]（P〈0．05），糖尿病组外周血sFas及sFasL水平高于糖尿病并发肺结核组、肺结核组（P〈0．05），sFasL以1000ng／L为分界值，糖尿病并发肺结核组及糖尿病组合计诊断符合率为90．00％（45／50）；糖尿病并发肺结核组、糖尿病组、肺结核组CD，±、CD4±T淋巴细胞明显低于对照组（0．3376±0．0712、0．2368±0．0803、0A801±0．0896比0．5849土0．0487和0．1798±0．0401、0．2100±0．0679、0．2312±0．0487比0．2811±0．0348）（P〈0．05），糖尿病并发肺结核组CD，±T淋巴细胞高于糖尿病组、低于肺结核组（P〈0．05），糖尿病并发肺结核组CD＋T淋巴细胞明显低于糖尿病组及肺结核组（P〈O．05），糖尿病并发肺结核组、糖尿病组CD＋T淋巴细胞高于对照组（0．3209±0．0707、0．2831±0．0794比0．2086±0．0589）（P〈0．05），糖尿病并发肺结核组CD8±T淋巴细胞高于糖尿病组及肺结核组（0．2287±0．0690）（P〈0．05）；糖尿病并发肺结核组、糖尿病组、肺结核组CD3‘、CD。＋、CD8±T淋巴细胞凋亡率高于对照组[（4．34±2．08）％、（3．22±2．12）％、（2．59±1．41）％比（1．01±0．38）％，（5．12±1．58）％、（4．82±1．98）％、（3．21±1．19）％比（1．78±0．53）％和（1．45±0．52）％、（2．31±2．01）％、（1．62±1．33）％比（1．07±0．38）％]（P〈0．05），糖尿病并发肺结核组、糖尿病组CD，＋、CD。＋T淋巴细胞凋亡率高于肺结核组（P〈0．05），糖尿病组CD＋T淋巴细胞凋亡率高于肺结核组（P〈0．05）。结论糖尿病并发肺结核患者外周血sFas及sFasL存在异常升高，CD＋、CD＋T淋巴细胞降低，提示患者存在免疫功能失调，sFas及sFasL可能参与了疾病的发生及发展过程，外周血sFasL含量还可作为鉴别糖尿病患者是否并发肺结核的辅助诊断指标。

Objective To explore the changes of the peripheral blood soluble Fas (sFas) and soluble FasL (sFasL) in patients of diabetes complicated with tuberculosis,in order to provide the basis for condition judgment and intervention.Methods The patients of diabetes complicated with tuberculosis (diabetes comphcated with tuberculosis group,25 cases),simple diabetes (diabetes group,25 cases),simple tuberculosis (tuberculosis group,25 cases) and healthy person (control group,25 cases) were selected.The peripheral blood sFas,sFasL and T-lymphocyte subsets were examined by enzyme-linked immunosorbent test.Results The peripheral blood sFas,sFasL in diabetes complicated with tuberculosis group,diabetes group,tuberculosis group was higher than that in control group[(7.91 ± 1.93),(8.74 ± 2.12),(7.86 ± 1.61)mg/L vs.(2.10 ±0.88) mg/L and (562.37 ± 196.38),(1512.32 ±303.48),(607.48 ± 102.53) ng/L vs.(263.18 ±46.32) ng/L](P＜ 0.05).The peripheral blood sFas,sFasL in diabetes group was higher than that in diabetes complicated with tuberculosis group and tuberculosis group (P ＜ 0.05).With sFasL 1000 ng/L as boundary value,the diagnostic coincidence rate of diabetes complicated with tuberculosis group and diabetes group was 90.00％ (45/50).CD3 +,CD4+ T-lymphocyte subsets in diabetes complicated with tuberculosis group,diabetes group,tuberculosis group was lower than that in control group (0.3376 ± 0.0712,0.2368 ± 0.0803,0.4801 ± 0.0896 vs.0.5849 ± 0.0487 and 0.1798 ± 0.0401,0.2100 ± 0.0679,0.2312 ± 0.0487 vs.0.2811 ± 0.0348) (P ＜ 0.05).CD3 + T-lymphocyte subsets in diabetes complicated with tuberculosis group was higher than that in diabetes group and lower than that in tuberculosis group (P ＜ 0.05).CD4+ T-lymphocyte subsets in diabetes complicated with tuberculosis group was lower than that in diabetes group,tuberculosis group(P ＜ 0.05).CD8+ T-lymphocyte subsets in diabetes complicated with tuberculosis group,diabetes group was higher than that in control group (0.3209 ± 0.0707,0.2831 ± 0.0794 vs.0.2086 ± 0.0589)(P ＜ 0.05).CD8+ T-lymphocyte subsets in diabetes complicated with tuberculosis group was higher than that in diabetes group and tuberculosis group (0.2287 ± 0.0690)(P ＜ 0.05).C D3 +,CD4+,CD8+ T-lymphocyte apoptotic rate in diabetes complicated with tuberculosis group,diabetes group,tuberculosis group was higher than that in control group [(4.34 ± 2.08)％,(3.22 ± 2.12)％,(2.59 ± 1.41)％ vs.(1.01 ± 0.38)％,(5.12 ± 1.58)％,(4.82 ± 1.98)％,(3.21 ± 1.19)％ vs.(1.78 ±0.53)％ and (1.45 ±0.52)％,(2.31 ±2.01)％,(1.62 ± 1.33)％ vs.(1.07 ± 0.38)％] (P ＜ 0.05).CD3 +,CD4+ T-lymphocyte apoptotic rate in diabetes complicated with tuberculosis group,diabetes group was higher than that in tuberculosis group (P ＜0.05).CD8+ Tlymphocyte apoptotic rate in diabetes group was higher than that in tuberculosis group (P ＜ 0.05).Conclusions The peripheral blood sFas and sFasL exists abnormal increase in patients of diabetes complicated with tuberculosis.CD3+,CD4+ T-lymphocyte decreasing shows that the patients exist immune function disorder.sFas and sFasL may be involved development process of disease,and the peripheral blood sFasL content can also be used as auxiliary indicators for identifying diabetes patients with tuberculosis.