外周血CD4^(+)、CD8^(+)T淋巴细胞的表达对成人隐匿性自身免疫糖尿病患者胰岛β细胞功能的影响

Effect of CD4^(+),CD8^(+)T lymphocytes in peripheral blood on pancreaticβcell furction in adult patients with latent autoimmune diabetes

目的探讨外周血CD4^(+)、CD8^(+)T淋巴细胞水平对成人隐匿性自身免疫糖尿病(latent autoimmune diabetes in adults,LADA)患者胰岛β细胞功能的影响。方法选择2020年1月至2022年1月庐江县人民医院收治的LADA患者87例作为研究对象;另选择同期健康体检者80例作为对照组。应用全自动生化分析仪测定空腹血糖(fasting blood glucose,FBG)水平,采用亲和层析微注法测定糖化血红蛋白A1c(hemoglobin A1c,HbA1c)水平;采用化学发光免疫分析法测定空腹C肽水平;采用稳态模型计算胰岛β细胞功能指数(homeostasis model assessment-β,HOMA-β)和胰岛素抵抗指数(homeostasis model assessment-index resistance,HOMA-IR);采用流式细胞术测定CD4^(+)、CD8^(+)T淋巴细胞水平。比较两组上述指标差异并采用Pearson分析CD4^(+)和CD8^(+)T淋巴细胞与FBG、HbA1c、空腹C肽、HOMA-β和HOMA-IR相关性。结果LADA组FBG和HbA1c高于对照组[(9.42±1.76)mmol/L比(5.17±0.68)mmol/L,(10.34±2.48)%比(5.64±1.26)%,t=20.25、15.24,P值均<0.05],空腹C肽低于对照组[(1.14±0.39)μg/L比(2.41±0.57)μg/L,t=16.92,P<0.05]。LADA组HOMA-β低于对照组[(65.87±21.42)比(97.42±18.28),t=10.20,P<0.05],而HOMA-IR高于对照组[(2.12±0.43)比(1.02±0.29),t=19.21,P<0.05]。LADA组CD4^(+)T淋巴细胞高于对照组[(42.42±7.85)%比(38.89±7.27)%,t=3.01,P<0.05],而CD8^(+)T淋巴细胞低于对照组[(32.26±5.53)%比(35.01±4.57)%,t=3.49,P<0.05]。经Pearson分析显示,CD4^(+)T淋巴细胞水平与FBG、HbA1c和HOMA-IR呈线性正相关(r=0.46、0.53、0.45,P值均<0.05),而与空腹C肽和HOMA-β呈线性负相关(r=-0.62、-0.59,P值均<0.05);CD8^(+)T淋巴细胞水平与FBG、HbA1c和HOMA-IR呈线性负相关(r=-0.42、-0.46、-0.52,P值均<0.05),而与空腹C肽和HOMA-β呈线性正相关(r=0.56、0.44,P值均<0.05)。结论LADA患者CD4^(+)T淋巴细胞水平升高,而CD8^(+)T淋巴细胞水平降低,且与胰岛β细胞功能密切相关,T淋巴细胞亚群失衡可能介导了胰岛β细胞的损伤。

Objective To investigate the effect of CD4^(+)and CD8^(+)T lymphocytes in peripheral blood and the effects on pancreaticβcell function in adult patients with latent autoimmune diabetes(LADA).Methods A total of 87 patients with LADA admitted to Lujiang County People's Hospital from January 2020 to January 2022 were selected as the study subjects;in addition,80 patients with physical examination in the hospital were selected as the control group.The fasting blood glucose(FBG)level was measured with a fully automated biochemical analyzer,the hemoglobin A1c(HbA1c)level was measured with affinity chromatography microinjection method,and the fasting C-peptide level was measured with chemiluminescence immunoassay;calculation of pancreatic islets using a steady-state modelβcell function index(HOMA-β)and insulin resistance index(HOMA-IR);the levels of CD4^(+)and CD8^(+)T lymphocytes were measured by flow cytometry.Compare the differences in the levels of the above indicators between two groups and use Pearson analysis to compare CD4^(+)and CD8^(+)T lymphocytes with FBG,HbA1c,fasting C-peptide,HOMA-βand HOMA-IR of correlation.Results FBG and HbA1c in LADA group were higher than those in control group[(9.42±1.76)mmol/L vs(5.17±0.68)mmol/L,(10.34±2.48)%vs(5.64±1.26)%,t=20.25,15.24,both P<0.05],fasting C-peptide was lower than that in control group[(1.14±0.39)μg/L vs(2.41±0.57)μg/L,t=16.92,P<0.05].HOMA-βin LADA group was lower than that in control group[(65.87±21.42)vs(97.42±18.28),t=10.20,P<0.05],while HOMA-IR was higher than that in control group[(2.12±0.43)vs(1.02±0.29),t=19.21,P<0.05].CD4^(+)T lymphocytes in LADA group were higher than those in control group[(42.42±7.85)%vs(38.89±7.27)%,t=3.01,P<0.05],while CD8^(+)T lymphocytes were lower than those in control group[(32.26±5.53)%vs(35.01±4.57)%,t=3.49,P<0.05].Pearson analysis showed that the level of CD4^(+)T lymphocytes was positively correlated with FBG,HbA1c and HOMA-IR(r values were 0.46,0.53 and 0.45,respectively,all P values<0.05),but negatively correlated with fasting C-peptide and HOMA-β(r values were-0.62 and-0.59,respectively,both P values<0.05).The level of CD8^(+)T lymphocytes was negatively correlated with FBG,HbA1c and HOMA-IR(r values were 0.42,0.46 and 0.52,respectively,all P values<0.05),but negatively correlated with fasting C-peptide and HOM.Conclusion The level of CD4^(+)T lymphocytes in adult patients with concealed autoimmune diabetes is increased,while the level of CD8^(+)T lymphocytes is decreased,and it is related to the pancreatic isletsβcell function is closely related,and it is believed that the imbalance of T lymphocyte subsets may mediate pancreatic isletsβcell damage.