老年2型糖尿病并阻塞性睡眠呼吸暂停低通气综合征患者的免疫与临床相关性  

Correlation of immune status with clinical features of obstructive sleep apnea syndrome in elderly type 2 diabetes mellitus patients

作　　者：夏瑾玮[1] 张省亮[1] 张莉[1] 易红良[2] 钟远[1] 

机构地区：[1]上海交通大学附属第六人民医院老年科,上海200233 [2]上海交通大学附属第六人民医院五官科,上海200233

出　　处：《中华老年多器官疾病杂志》2013年第5期375-380,共6页Chinese Journal of Multiple Organ Diseases in the Elderly

摘　　要：目的探讨2型糖尿病（T2DM）并阻塞性睡眠呼吸暂停低通气综合征（OSAS）患者T淋巴细胞亚群（CD3＋、CD4＋、CD8＋、CD19＋）和自然杀伤细胞（NK）百分率变化的意义及其临床相关性。方法2011年6月至2012年6月在上海交通大学附属第六人民医院老年科住院患者符合1999年WHO关于2型糖尿病诊断标准的患者50例，按照2002年《中华结核和呼吸杂志》公布的阻塞性睡眠呼吸暂停低通气综合征诊治指南（草案），根据患者是否存在OSAS分为T2DM组（30例）、T2DM＋OSAS组（20例），同期选择单纯OSAS患者为OSAS组（25例），正常对照组（NC组25例）。采用稳态模型计算胰岛素抵抗指数（HOMA-IR）；应用流式细胞仪单克隆免疫荧光法和放射免疫法检测外周血T淋巴细胞、NK细胞和胰岛素水平，并分别对T细胞亚群和NK细胞百分率的变化与睡眠呼吸紊乱主要参数（AHI）、体质量指数（BMI）、空腹血糖（FBG）、空腹胰岛素（FINS）及胰岛素抵抗指数（HOMA-IR）指数进行了多元回归分析。结果（1）本研究中，T2DM＋OSAS组的BMI、血氧饱和度（Sp02）及心脑血管并发症的差异有显著性（P〈0．01）。（2）各实验组的AHI、FBG、FINS和HOMA．IR指数均高于正常对照组，夜间最低Sp02低于NC组（P〈0．05，P〈0．01）。（3）各实验组的外周血CD3＋、CD4＋、CD19＋、NK及CD4＋／CD8＋比值均明显低于NC组（P〈0．01）；CD8＋T细胞数量与NC组比较，差异无统计学意义（P〉0．05）。（4）直线相关性分析提示，AHI变化与FINS及HOMA-IR呈正相关。（5）多元回归分析提示，外周血CD4＋T细胞亚群及NK细胞的变化与AHI、BMI、FBG、HOMA-IR具有明显相关性。结论免疫调节异常参与了T2DM和OSAS的发生发展，合理使用免疫调节治疗可能是治疗糖尿病并睡眠呼吸暂停综合征的另一新途径。Objective To explore the changes and significance of lymphocyte subsets （CD3＋, CD4＋, CD8＋ and CD19＋ cells） and natural killer （NK） cells in type 2 diabetes mellitus （T2DM） patients with obstructive sleep apnea syndrome （OSAS）. Methods Fifty patients with identified T2DM according to the WHO criteria for diagnosis of T2DM admitted to our hospital from June 2011 to June 2012 was enrolled in this study. Then, they were divided into T2DM group （n = 30） and T2DM＋OSAS group （n = 20） according to the diagnosis and treatment guidelines of OSAS published in the Chinese Journal of Tuberculosis and Respiratory Disease in 2002. Another 25 healthy subjects without OSAS or T2DM, and 25 OSAS patients hospitalized in the same period were included as healthy control group and OSAS group, respectively. Minimal model of homeostasis was used to represent insulin resistance （HOMA-IR）. Lymphocyte subsets in the peripheral blood and insulin levels in all four groups were detected by flow cytometry and radioimmunity. Multiple regression analysis was carried out to study the correlation of the percentages of lymphocyte subsets and NK ceils with the apnea/hypopnea index （AHI）, body mass index （BMI）, fasting blood glucose （FBG）, fasting insulin （FINS）, and HOMA-IR. Results The patients of T2DM＋OSAS group had significantly higher BMI, lower oxygen saturation （SpO2）, and high incidence of cardio-cerebrovascular complications than those from normal control （P 〈 0.01）. AHI, FBG, FINS and HOMA-IR were significantlyhigher, while the lowest SpO2 during the night was significantly lower in the OSAS, T2DM and T2DM＋OSAS groups than in normal control （P〈 0.05, P〈 0.01）. The percentages of CD3＋, CD4＋, CD19＋lymphocytes, NK cells and the ratio of CD4＋/CD8＋ were significantly lower in the above 3 groups than in normal control （P 〈 0.05）, but there was no significant difference in the percentage of CD8＋ cells（P〉 0.05）. Linear correlation analysis showed tha

关 键 词：老年人 糖尿病 2型 睡眠呼吸暂停 阻塞性 

分 类 号：R592[医药卫生—老年医学] R587.1[医药卫生—内科学]