血浆免疫指标变化与糖尿病足部感染

The Changes of Immune Indices and Diabetic Foot Infections

目的:了解机体免疫功能在糖尿病足的变化,探讨糖尿病足的防治办法。方法:以健康志愿者(ＮＣ)和糖尿病(ＳＤＭ)患者为对照,动态观测糖尿病足(ＤＦ)治疗前及治疗过程中可溶性白介素－Ⅱ受体(ｓＩＬ－２Ｒ)、自然杀伤细胞活性(ＮＫＣＡ)、Ｔ淋巴细胞亚群(ＣＤ３、ＣＤ４、ＣＤ８)、免疫球蛋白(ＩｇＧ、ＩｇＭ、ＩｇＡ)、补体(Ｃ３、Ｃ４、ＣＨ５０)及空腹血糖(ＦＰＧ)、餐后２ ｈ血糖(ＰＧ２ｈ)。结果:①ＤＦ和 ＳＤＭ组ｓＩＬ－２Ｒ显著高于 ＮＣ组(Ｐ＜０．０５),ＮＫＣＡ及 ＣＤ４/ＣＤ８显著低于ＮＣ组(Ｐ＜０．０５);同时ＤＦ患者ｓＩＬ－２Ｒ较ＳＤＭ患者显著增高(Ｐ＜０．０５),ＮＫＣＡ及 ＣＤ４/ＣＤ８ 较ＳＤＭ患者显著降低(Ｐ＜０．０５);在 ＤＦ组中溃疡及坏疽患者 ｓＩＬ－２Ｒ显著高于高危足患者,ＮＫＣＡ显著低于高危足患者(均 Ｐ＜０．０５);②２５例 ＤＦ患者治疗后,ｓＩＬ－２Ｒ逐渐下降,ＮＫＣＡ、ＣＤ４/ＣＤ８逐渐升高,至观察终点与治疗前比较,三者差异均有显著性(Ｐ＜０．０５);③在ＤＦ患者,ｓＩＬ－２Ｒ与病情严重性呈显著正相关(ｒ＝０．７３４,Ｐ＜０．０１),与治疗过程中ＰＧ２ｈ变化亦呈显著正相关(ｒ＝０．４６７,Ｐ＜０．０５),ＮＫＣＡ与ＦＰＧ,ＰＧ２ｈ呈显著负相关(ｒ＝?

Objective: To study the changes of immune function in patients with diabetic foot infections before and during treatment. Methods: soluble interleukin -2 receptor( sIL -2R) .natural killer cell activity (NKCA) ,T cell subsets ( CD3,CD4,CD8) , immunoglobulins ( IgG, IgM , IgA),complements ( C3 , C4 and CH50) fast blood sugar(FBS) and blood sugar 2 hours after meal ( BS2h ) in patients with diabetic foot infections ( DF) were dynamically monitored before and during the treatment and compared with those of normal controls ( NC ) and diabetes mellitus (DM). Results:(1)In DM and DF groups,the sIL-2R level was significantly higher,while NKCA and CD4/CD8 significantly lower than that in the NC group (P <0. 05). The level of sIL - 2R was significantly higher, while NKCA and CD4/CD8 were signicantly lower in DF group than that in DM group( P < 0. 05). The level of sIL - 2R was significantly higher, and NKCA was significantly lower in DF patients with ulcer and gangrene than in patients with high danger foot (P <0. 05). After the treatment, the levels of sIL -2R droped, while NKCA and CD4/CD8 increased gradually in 25 patients with DF. In DF patients,the sIL -2R level exhibited a postive linear correlation with both the severity of the disease and the PG2h level ( r = 0. 734, P < 0. 01 and r = 0. 467, P < 0. 05, respectively) .while NKCA showed a negative linear correlation with FPG and PG2h (r = - 0. 512,r = -0. 479, respectively, P < 0. 05 ). Conclusions: These results indicate that impaired immune function related to hyperglycemia may cause diabetic foot infections, and infections may deteriorate diabetes mellitus, which further decrease the immune function. Treatment of diabetes mellitus to normalize hyperglycemia will help in the prevention and treatment of diabetes foot infection.