糖尿病合并社区获得性肺炎患者血浆CD4^+、CD4^+CD25^+调节性T细胞变化的临床意义

Clinical significance of plasma CD4^+ cell and CD4^+CD25^+ regulatory T cell changes in patients with diabetes mellitus combined with CAP

目的:探讨糖尿病合并社区获得性肺炎患者血浆CD4+、CD4+CD25+调节性T细胞的变化及临床意义。方法:选择糖尿病合并社区获得性肺炎患者62例为观察组,入院后进行相关降糖及抗感染治疗,观察患者入院时、入院治疗8周后血浆CD4+、CD4+CD25+T细胞水平,并探讨其与血糖控制水平的关系。另选择30例健康体检者为对照组。结果:治疗前后,观察组血浆CD4+细胞水平显著低于健康对照组,CD4+CD25+及CD4+CD25+/CD4+比值高于对照组(P<0.05或P<0.01)。与治疗前比较,治疗8周后观察组CD4+细胞水平升高(P<0.05),CD4+CD25+及CD4+CD25+/CD4+比值显著降低(P<0.01)。观察组依据治疗效果分为治愈组、有效组及无效组,CD4+水平随疗效的增加而增加,CD4+CD25+水平及CD4+CD25+/CD4+比值随疗效的增加而降低,3组比较差异具有统计学意义(P<0.05)。CD4+T细胞水平与餐后2 h血糖(2 h PBG)水平呈显著负相关(r=-0.522,P<0.05)。结论:检测CD4+T细胞、CD4+CD25+调节性T细胞变化,可客观评价糖尿病合并社区获得性肺炎患者免疫功能。

Objective： To explore the changes of plasma CD4^＋、CD4^＋CD25^＋regulatory T cells and their significance in patients with diabetes mellitus combined with community-acquired pneumonia（ CAP）. Methods： A total of 62 patients with diabetes mellitus combined with CAP were selected as observation group and treated with corresponding hypoglycemic and anti-infection treatment after being hospitalized. Plasma CD4^＋、CD4^＋CD25^＋T cell levels before hospitalization and 8 weeks after treatment were observed to explore their relationship with controlling level of blood sugar. And another 30 healthy examiners served as control group. Results： Before and after hospitalization,observation group was evidently lower in observation group CD4^＋cell level than control group,but markedly higher in CD4^＋CD25^＋ and CD4^＋CD25^＋/ CD4^＋ratio than control group（ P〈0. 05,P〈0. 01）. Compared with treatment before,8 weeks after hospitalization,CD4＋cell level increased obviously（ P〈0. 05） while CD4^＋CD25^＋and CD4^＋CD25^＋/ CD4＋ratio decreased significantly in observation group（ P〈0. 01）. Observation group was divided into recovery group,effective group and non-effective group,according to therapeutic efficacy. CD4^＋cell level increased while CD4^＋CD25^＋and CD4^＋CD25^＋/ CD4^＋ratio decreased along with efficacy,and there were significant differences among 3 groups（ P〈0. 05）. And CD4^＋cell level was in negative association with plasma blood glucose level 2 h after meal（ 2 h PBG）（ r =- 0. 522,P〈0. 05）. Conclusion： Detecting CD4＋cell level and CD4^＋CD25^＋regulatory T cell changes can objectively evaluate the immunological function of patients with diabetes mellitus combined with CAP.