CD4＋CD28null T细胞与2型糖尿病患者动脉粥样硬化进展的关系  

Relationship between CD4 ＋ CD28nuull T cell and atherosclerosis progression in patients with type 2 diabetes

作　　者：高祖华[1] 邱夏桑[1] 汤珂珂[1] 陈亮[1] 周金虎[1] 

机构地区：[1]浙江省台州医院内分泌科,浙江省临海市317000

出　　处：《中华医学杂志》2015年第48期3899-3902,共4页National Medical Journal of China

基　　金：浙江省医药卫生科技计划（2011KYA160）;浙江省台州市科技计划（11KY03）

摘　　要：目的 探讨CD4＋ CD28nullT细胞亚群在2型糖尿病患者动脉粥样硬化进展过程中的作用.方法 选取浙江省台州医院内分泌科188例2型糖尿病患者,以彩色多普勒超声分析动脉粥样硬化情况,将颈动脉内膜厚度＞1.1 mm或存在斑块的2型糖尿病患者归为颈动脉粥样硬化组（95例）,其余为对照组（93例）.将颈动脉粥样硬化组按有无斑块和内膜增厚,又分为增厚＋斑块组（37例）、增厚组（30例）、斑块组（28例）.采用流式细胞仪检测外周血CD4＋ CD28nullT细胞亚群的比例.比较分析颈动脉粥样硬化组和对照组外周血CD4＋ CD28nullT细胞亚群的比例,并分析其与年龄、C反应蛋白（CRP）、血糖、血脂、体质指数（BMI）、腰围、臀围、舒张压、收缩压等的关系.本研究通过浙江省台州医院伦理委员会审批.结果 颈动脉粥样硬化组CD4＋ CD28null T细胞亚群的比例明显高于对照组[（4.07±3.21）％比（2.99±2.34）％,P＜0.01];增厚＋斑块组CD4＋ CD28nullT细胞亚群的比例显著高于斑块组和增厚组（均P＜0.05）,而斑块组CD4＋ CD28nullT细胞亚群比例显著高于增厚组（P＜0.05）.Logistic回归分析提示,CRP、餐后2h血糖（PBG）、CD4＋ CD28null T细胞亚群比例是2型糖尿病患者动脉粥样硬化的独立影响因素.采用多因素线性回归方法分析影响CD4＋ CD28nullT细胞亚群比例的因素,结果表明CD4＋ CD28nullT细胞亚群的比例与CRP呈线性相关（β=1.781,P＜0.01）.结论 2型糖尿病动脉粥样硬化患者具有更高的CD4＋CD28nullT细胞比例,且随着动脉粥样硬化进展而增加;CD4＋ CD28nullT细胞亚群可能通过介导炎症反应影响2型糖尿病患者动脉内膜的增厚以及斑块的形成和发展.Objective To explore the effect of CD4 ＋ CD28null T cell on occurrence and progression of atherosclerosis in patients with type 2 diabetes.Methods A total of 188 patients who were diagnosed as type 2 diabetes in the department of endocrinology were selected in this study.The carotid atherosclerosis was detected using color Doppler ultrasound.The patients with intima-media thickness 〉 1.1 mm or plaques were classified as the carotid atherosclerosis group （95 cases）,the others were classified as the control group （93 cases）.According to the intima-media thickening and plaques,carotid atherosclerosis group was divided into three subgroups：the thickening group （30 cases）,the plaque group （28 cases） and the thickening ＋ plaque group （37 cases）.Percentage of CD4 ＋ CD28null T cell in peripheral blood was detected using a flow cytometry,and thus compared and analyzed between the carotid atherosclerosis group and the control group.The relationships between percentage of CD4 ＋ CD28null T cell and age,C-reactive protein （CRP）,blood sugar,blood lipids,the body mass index （BMI）,waist circumference,hip circumference,diastolic blood pressure,systolic blood pressure and other data were also analyzed.Results Percentage of CD4 ＋ CD28null T cell of the carotid atherosclerosis group was significantly higher than that of the control group （4.07% ± 3.21% vs 2.99% ± 2.34%,P 〈 0.01）.Percentage of CD4 ＋ CD28null T cell of the thickening ＋ plaque group was higher than that of the plaque group and thickening group （both P 〈 0.05）,and percentage of CD4 ＋ CD28null T cell of the plaque group was higher than the thickening group （P 〈 0.05）.Logistic regression analysis indicated that CRP,FPG and percentage of CD4 ＋ CD28null T cell were the independent risk factors of atherosclerosis in patients with type 2 diabetes.Furthermore,multiple linear regression analysis showed that percentage of CD4＋ CD28null T cell was linear correlated to CRP （P 〈0.01）.Conclusion The type 2

关 键 词：糖尿病  2型 动脉粥样硬化 T淋巴细胞亚群 

分 类 号：R587.2[医药卫生—内分泌]