2型糖尿病患者循环CD4^(+)T细胞亚群与肾脏损伤的相关性研究

Correlation study between circulating CD4^(+)T cell subsets and diabetic kidney disease in patients with type 2 diabetes mellitus

目的探讨2型糖尿病(type 2 diabetes milletus,T2DM)和糖尿病肾脏病(diabetic kidney disease,DKD)患者外周血CD4^(+)T细胞亚群比例的变化及其意义。方法纳入113例新诊断T2DM患者,根据是否合并DKD,分为T2DM组63例和DKD组50例,另选择30例健康志愿者作为对照组,比较三组组受试者外周血Th1、Th2、Tregs等CD4^(+)T细胞亚群的差异。Spearman相关分析估算肾小球滤过率(estimated glomerular filtration rate,eGFR)与CD4^(+)T细胞亚群之间的相关性,多元线性回归分析探讨eGFR变化的影响因素。结果三组间外周血Th1比例、Th1/Th2比值和Tregs比例差异有统计学意义,T2DM组和DKD组患者外周血Th1比例和Th1/Th2比值高于对照组,Tregs比例低于对照着。而且,DKD组外周血Th1比例和Th1/Th2比值高于T2DM组,Tregs比例低于T2DM组。T2DM患者外周血Th1/Th2比值与eGFR呈负相关关系,外周血Tregs比例与eGFR呈正相关关系。通过多元线性回归分析显示,SBP、Tregs、Th1/Th2比值和总胆固醇是影响T2DM患者eGFR的危险因素。结论DKD患者体内存在CD4^(+)T细胞稳态失衡,且与eGFR水平下降密切相关。

Objective To investigate the changes and significance of circulating CD4^(+)T cell subsets in patients with type 2 diabetes mellitus(T2DM)and diabetic kidney disease(DKD).Methods We recruited 113 patients with newly diagnosed T2DM and 30 healthy volunteers,and compared the differences of the CD4^(+)T cell subsets,including Th1,Th2 and Tregs,in the peripheral blood of subjects from the three groups.Spearman's rank correlation analysis was conducted to explore the correlation between estimated glomerular filtration rate(eGFR)and CD4^(+)T cell subsets.Multiple linear regression analysis was used to explore the influencing factors of eGFR changes.Results There were significant differences in the proportion of peripheral blood Th1,Th1/Th2 ratio and the proportion of Tregs among three groups.The Th1 ratio and Th1/Th2 ratio in patients with T2DM and DKD were higher than those of control group,while the proportion of Tregs was lower than that of control group.Moreover,the proportion of Th1 and Th1/Th2 ratio in patients with DKD were higher than those of T2DM group,and the proportion of Tregs was lower than that of T2DM group.There was a negative correlation between the Th1/Th2 ratio and eGFR,and a positive correlation between the proportion of Tregs and eGFR.Multiple linear regression analysis revealed that systolic blood pressure,Tregs,Th1/Th2 ratio and total cholesterol were risk factor for eGFR in patients with T2DM.Conclusion Imbalance in CD4^(+)T cell homeostasis is present in patients with DKD,which is closely related to the decrease of eGFR level.