血糖对严重脓毒症合并2型糖尿病患者程序性死亡因子-1表达的影响

The effect of blood glucose levels on programmed death-1 in patients with severe sepsis and type 2diabetes mellitus

目的探讨严重脓毒症合并2型糖尿病（type 2 diabetes mellitus，T2DM）患者不同人院血糖水平对外周血T淋巴细胞表达的程序性死亡因子-1（processeddeath-1，PD-1）及患者28d预后的影响。方法共有106例严重脓毒症合并T2DM患者和50名健康对照者纳入此项前瞻性研究。根据患者入院时血糖水平分为三组：血糖〈6．1mmol／L组、血糖6．1～11．1mmol／L组、血糖〉11．1mmoL／L组。随访患者28d的生存情况，并检测其外周血PD-1＋CIM＋T淋巴细胞和PD-1＋CD8＋T淋巴细胞水平。采用Kaplan-Meier生存曲线比较不同血糖水平患者的28d死亡风险。结果严重脓毒症合并T2DM患者的外周血PD-1＋CD4＋T淋巴细胞水平和PD-1＋CD8＋T淋巴细胞水平均高于健康对照者。血糖〈6．1mmol／L组的病死率（56．52％）高于血糖6．1-11．1mmol／L组（24．3％）和血糖〉11．1mmol／L组（28．3％）（P〈0．05）。Kaplan-Meier生存曲线显示，血糖〈6．1mmol／L的患者28d死亡风险高于血糖6．1～11．1mmol／L和血糖〉11．1mmol／L的患者（Logrank检验值分别为6．523和5．794，P值分别为0．011和0．016）。血糖〈6．1mmol／L组的PD-l＋CD8＋T淋巴细胞水平高于血糖6．1-11．1mmol／L组和血糖〉11．1mmol／L组（P=0．013）。结论入院血糖〈6．1mmol/L的严重脓毒症合并T2DM患者可能存在严重的免疫抑制，应更加重视这类患者的28d死亡风险。

Objective To investigate the effect of blood glucose levels on peripheral blood T lymphocyte programmed death-1 factor （PD-1） and the prognosis of 28-day in patients with severe sepsis and type 2 diabetes mellitus （ T2DM ）. Methods A total of 106 severe sepsis patients with T2DM and 50 healthy subjects as controls were included in this prospective study. According to the blood glucose levels at admission, patients were divided into three groups： the blood glucose 〈 6. 1 mmol/L group, the blood glucose 6. 1 to 11.1 mmol/L group, and the blood glucose 〉 11. 1 mmol/L group. The patients were followed up for trace the 28-day outcomes, and the levels of peripheral blood PD-1 ＋ CD4 ＋ T lymphocytes and PD-1 ＋ CD8 ＋ T lymphocytes were detected. The Kaplan - Meier survival curves were used to compare the risk of 28-day death in patients with different blood glucose levels. Results The levels of peripheral blood PD-1 ＋ CD4 ＋ T lymphocytes and PD-1 ＋ CD8 ＋ T lymphocytes were higher in patients with severe sepsis and T2DM than those in healthy subjects. The mortality of blood glucose 〈 6.1 mmol/L group（56. 52% ） was higher than that of blood glucose 6. 1 to 11.1 mmol/L group （24. 3% ） and the blood glucose 〉 11.1 mmol/L group （28. 3% ） （P 〈0. 05）, Kaplan-Meier survival curve showed that the 28-day mortality risk of patients with blood glucose 〈 6. 1 mmol/L was higher than that of patients with blood glucose 6. 1 to 11.1 mmol/L group and blood glucose 〉 11.1 mmol./L group （The Log-rank test values were 6. 523 and 5. 794, the P values were 0. 011 and 0. 016）. The level of PD1 ＋ CD8 ＋ T lymphocytes in the blood glucose 〈 6. 1 mmol/L group was higher than that in the blood glucose 6. 1 to 11.1 mmol/L group and the blood glucose 〉 11.1 mmol/L group （P = 0. 013 ）. Condusions The patients with severe sepsis and T2DM getting blood glucose level 〈 6. 1 mmol/L at admission may be suffered from severe immunosuppression, and more attention should be paid to the risk of 28-days mortality in these patients.