| 摘要: |
| ［摘要］ 目的 探讨正常范围内CD4+ T细胞水平对2型糖尿病（T2DM）患者胰岛素抵抗的影响。方法 招募2021年9月至2022年6月徐州医科大学附属医院收治的T2DM患者269例，依据正常范围内的CD4+ T细胞水平将其分为4组：A组58例，414～670个/μl；B组78例，671～927个/μl；C组74例，928～1 183个/μl；D组59例，1 184～1 440个/μl。对研究对象的干扰素-γ（INF-γ）、白细胞介素-17(IL-17)、总胆固醇（TC）、甘油三酯（TG）、C反应蛋白（CRP）等指标进行检测。行口服葡萄糖耐量试验（OGTT）及胰岛素释放试验，计算稳态模型胰岛β细胞分泌指数（HOMA-β），胰岛素抵抗指数（HOMA-IR）和Matsuda指数评估胰岛素敏感性IS（ISIM），分析各指标间的关联性。结果 四组CRP、INF-γ、IL-17、糖化血红蛋白（HbA1c）、空腹血糖（FPG）、HOMA-IR、ISIM比较差异有统计学意义（P<0.05)，且CRP、INF-γ、IL-17、HbA1c、FPG、HOMA-IR与CD4+ T细胞水平呈正关联，ISIM与CD4+ T细胞水平呈负关联。Spearman秩相关性分析结果显示，HOMA-IR与CD4+ T细胞、CRP、HbA1c、FBG、IL-17、INF-γ呈显著正相关（P<0.05），与ISIM呈显著负相关（P<0.05）。多元线性回归分析结果显示，CD4+ T细胞、FBG、IL-17、INF-γ水平与HOMA-IR水平呈正关联（P<0.05）。控制FPG及其他混杂因素（CRP、HbA1c、IL-17、INF-γ）后，偏相关分析结果显示，HOMA-IR与CD4+ T细胞呈正相关（r=0.343，P<0.05）。结论 在CD4+ T细胞正常水平范围内，T2DM患者的CD4+ T细胞水平越高，其胰岛素抵抗越重，外周组织对胰岛素的敏感性也更低。 |
| 关键词: 2型糖尿病 炎症因子 胰岛素抵抗 CD4+ T细胞 |
| DOI：10.3969/j.issn.1674-3806.2023.04.15 |
| 分类号:R 587.1 |
| 基金项目:江苏省徐州市科学技术局社会发展项目（编号：KC15SH089） |
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| Effects of normal range of CD4+ T cell levels on insulin resistance in patients with type 2 diabetes mellitus |
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ZHANG Zhen-hua, SUN Juan, HE Miao-miao, et al.
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The First Clinical Medical College of Xuzhou Medical University, Jiangsu 221000, China
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| Abstract: |
| ［Abstract］ Objective To investigate the effects of normal range of CD4+ T cell levels on insulin resistance in patients with type 2 diabetes mellitus(T2DM). Methods Two hundred and sixty-nine patients with T2DM who were admitted to the Affiliated Hospital of Xuzhou Medical University from September 2021 to June 2022 were recruited and according to their normal range of CD4+ T cell levels the patients were divided into 4 groups: group A(58 cases, 414-670 cells /μl), group B(78 cases, 671-927 cells /μl), group C(74 cases, 928-1 183 cells /μl) and group D(59 cases, 1 184-1 440 cells /μl). The indicators of the subjects including interferon-γ(INF-γ), interleukin-17(IL-17), total cholesterol(TC), triglyceride(TG) and C-reactive protein(CRP) were detected. Oral glucose tolerance test(OGTT) and insulin release test were performed on the patients. Homeostasis Model Assessment-β(HOMA-β), Homeostasis Model Assessment-Insulin Resistance Index(HOMA-IR) and Matsuda Insulin Sensitivity Index(ISIM) were calculated, and the correlation among all the indicators was analyzed. Results There were statistically significant differences in CRP, INF-γ, IL-17, glycosylated hemoglobin(HbA1c), fasting plasma glucose(FPG), HOMA-IR and ISIM among the four groups(P<0.05). CRP, INF-γ, IL-17, HbA1c, FPG and HOMA-IR were positively correlated with CD4+ T cell levels, while ISIM was negatively correlated with CD4+ T cell levels. The results of Spearman rank correlation analysis showed that HOMA-IR was significantly positively correlated with CD4+ T cells, CRP, HbA1c, FBG, IL-17 and INF-γ(P<0.05), and was significantly negatively correlated with ISIM(P<0.05). The results of multiple linear regression analysis showed that CD4+ T cells, FBG, IL-17, INF-γ levels were positively correlated with HOMA-IR levels(P<0.05). After controlling FPG and the other confounding factors(CRP, HbA1c, IL-17 and INF-γ), the results of partial correlation analysis showed that HOMA-IR was positively correlated with CD4+ T cells(r=0.343, P<0.05). Conclusion Within the normal range of CD4+ T cell levels, the higher the level of CD4+ T cells in patients with T2DM, the more severe the insulin resistance and the lower the sensitivity of peripheral tissues to insulin. |
| Key words: Type 2 diabetes mellitus(T2DM) Inflammatory cytokines Insulin resistance CD4+ T cells |
