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目的探讨CD4~+ CD28~(null)T细胞与糖尿病微血管病变的关系。方法选取内分泌科141例2型糖尿病患者,按是否存在微血管病变分为单纯糖尿病组(T2DM组)、糖尿病视网膜病变组(DR组)、糖尿病肾病组(DN组)、糖尿病视网膜病变合并糖尿病肾病组(DR+DN组)。另选择台州医院体检中心的26名健康体检者为正常对照组。比较分析各组CD4~+ CD28~(null)T细胞的表达及临床特点,并分析影响糖尿病微血管病变的相关因素。结果与对照组相比,各糖尿病组CD4~+ CD28~(null)T细胞的表达均明显升高(χ~2=19.98,P<0.01)。DR组、DN组、DR+DN组与T2DM组相比,CD4~+ CD28~(null)T细胞的表达均升高(Z=-2.19、-2.87、-2.67,均P<0.05),炎症指标CRP也升高(Z=-3.11、-2.36、-2.86,均P<0.05)。而DR组、DN组、DR+DN组之间CD4~+ CD28~(null)T细胞的表达和CRP的差异无统计学意义。Logistic回归分析显示CD4~+ CD28~(null)T细胞的表达、CRP及腰围是糖尿病微血管病变的独立影响因素。结论 2型糖尿病患者CD4~+ CD28~(null)T细胞亚群的表达高于健康体检者,而存在微血管病变的2型糖尿病患者具有更高的CD4~+ CD28~(null)T细胞亚群的表达。CD4~+ CD28~(null)T细胞可独立影响糖尿病微血管病变的进展。
Objective To investigate the relationship between CD4 ~ + CD28 ~ (null) T cells and diabetic microangiopathy. Methods A total of 141 patients with type 2 diabetes mellitus were enrolled in the Department of Endocrinology. Diabetic nephropathy group (DN group), diabetic retinopathy (T2DM group), diabetic retinopathy group (diabetic retinopathy group), diabetic nephropathy group (DR + DN group). Another choice of Taizhou Hospital Physical Examination Center of 26 healthy people as normal control group. The expression and clinical features of CD4 ~ + CD28 ~ (null) T cells in each group were compared and analyzed, and the related factors influencing diabetic microangiopathy were analyzed. Results Compared with the control group, the expression of CD4 ~ + CD28 ~ (null) T cells in each diabetic group was significantly increased (χ ~ 2 = 19.98, P <0.01). Compared with T2DM group, the expression of CD4 ~ + CD28 + T cells in DR group, DN group and DR + DN group increased (Z = -2.19, -2.87, -2.67, all P <0.05) CRP also increased (Z = -3.11, -2.36, -2.86, both P <0.05). There was no significant difference in the expression of CD4 ~ + CD28 ~ (null) T cells and CRP between DR group, DN group and DR + DN group. Logistic regression analysis showed that the expression of CD4 ~ + CD28 ~ (null) T cells, CRP and waist circumference were independent influencing factors of diabetic microangiopathy. Conclusions The expression of CD4 ~ + CD28 + T cells in type 2 diabetic patients is higher than that in healthy subjects, while patients with type 2 diabetes mellitus with type 2 diabetes have higher CD4 ~ + CD28 + T cell subsets expression. CD4 ~ + CD28 ~ (null) T cells can independently affect the progress of diabetic microangiopathy.