2型糖尿病患者胰岛素强化治疗后胰岛素抵抗改善与T淋巴细胞亚群相关性的研究

Correlation between the improvement of insulin resistance and T lymphocyte subsets in type 2 diabetes mellitus patients after intensive insulin therapy

目的 探讨T2DM患者Ins强化治疗后IR改善与T淋巴细胞亚群的相关性。方法 选取2020年2月至2023年3月于我院内分泌科治疗的T2DM患者160例,根据是否有DM家族史(FHD)分为无FHD的T2DM组(n=80)和有FHD的FHD组(n=80)。比较两组治疗前后血糖、胰岛细胞功能、T淋巴细胞亚群及细胞炎症因子水平变化。Pearson相关分析胰岛素抵抗指数(HOMA-IR)与T淋巴细胞亚群的相关性,多元线性回归分析T2DM患者IR的影响因素。结果 T2DM组治疗后FPG、2 hPG及血糖变异系数(CV)低于治疗前(P<0.05),FHD组FPG、2 hPG、睡前血糖及CV低于治疗前(P<0.05)。治疗后T2DM组FPG、2 hPG及CV低于FHD组(P<0.05)。两组治疗后FC-P、2 hC-P、HOMA-β、IL-10高于治疗前(P<0.05),HOMA-IR、IL-21、IL-1β、CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)低于治疗前(P<0.05)。FHD组治疗后FC-P、2 hC-P、HOMA-β、IL-10、CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)低于T2DM组(P<0.05),HOMA-IR、IL-21、IL-1β高于T2DM组(P<0.05)。Pearson相关分析显示,HOMA-IR与CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)呈正相关(P<0.05)。多元线性回归分析显示,BMI、CD8^(+)是T2DM患者IR的影响因素。结论 Ins强化治疗改善T2DM患者胰岛β细胞功能及IR,IR与CD8^(+)T淋巴细胞水平升高相关。

Objective To investigate the correlation between the improvement of insulin resistance(IR)and T lymphocyte subsets in patients with type 2 diabetes mellitus(T2DM)after intensive insulin therapy.Methods A total of 160 patients with T2DM who were treated in the endocrinology department of our hospital from February 2020 to March 2023 were selected.They were divided into simple T2DM group(n=80)and T2DM combined with family history of diabetes mellitus(FHD)group(n=80)based on whether they had FHD.The changes in blood glucose,pancreatic islet cell function,T lymphocyte subsets,and inflammatory cytokine levels were compared before and after treatment between the two groups.Pearson correlation analysis was used to investigate the correlation between insulin resistance index(HOMA-IR)and T lymphocyte subsets,and multiple linear regression analysis was used to explore the influencing factors for IR in T2DM patients.Results After treatment,the FPG,2 hPG,and coefficient of variation(CV)of blood glucose were lower than before treatment in the T2DM group(P<0.05).In the FHD group,the FPG,2 hPG,bedtime blood glucose,and CV were lower after treatment than before treatment(P<0.05).After treatment,the FPG,2 hPG,and CV were lower in T2DM group than in FHD group(P<0.05).After treatment,FC-P,2 hC-P,HOMA-βand IL-10 were higher(P<0.05),while HOMA-IR,IL-21,IL-1β,CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)were lower than before treatment in both groups(P<0.05).After treatment,FC-P,2 hC-P,HOMA-βand IL-10 were higher,while HOMA-IR,IL-21,IL-1β,CD3^(+),CD4^(+),CD8^(+),CD4/CD8^(+)were lower in T2DM group than in FHD group(P<0.05).Pearson correlation analysis showed that HOMA-IR was positively correlated with CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+)(P<0.05).Multiple linear regression analysis shows that BMI and CD8^(+)are influencing factors for IR in T2DM patientss..Conclusions Intensive insulin therapy can improve the isletsβcell function inpatients with T2DM and IR.There is a correlation between IR and the increase of CD8T lymphocyte level in patients.