2型糖尿病合并全身炎症反应综合征患者内毒素耐受现象分析  

Analysis of endotoxin tolerance phenomenon in T2DM patients with systemic inflammatory response syndrome

作　　者：刘冀琴[1] 任党利[1] 吴玉秀[1] 杜振华[1] 靳颖[1] LIU Ji-qin;REN Dang-li;WU Yu-xiu;DU Zhen-hua;JIN Ying(Department of Clinical Experiment,Affiliated Hospital of Logistics University of PAP,Tianjin 300162,China)

机构地区：[1]武警后勤学院附属医院检验科,天津300162

出　　处：《武警后勤学院学报（医学版）》2018年第4期298-301,共4页Journal of Logistics University of PAP（Medical Sciences）

基　　金：武警后勤学院附属医院种子基金资助项目(FYM201208);武警后勤学院博士启动金资助项目(WHB201309)

摘　　要：【目的】研究2型糖尿病(type 2 diabetes mellitus,T2DM)患者并发全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)时机体炎症反应状态及是否发生内毒素耐受现象。【方法】选取单纯全身炎症反应综合征患者(SIRS组)100例,合并T2DM患者(SIRS^+T2DM组)100例,比较两组患者静脉血中细菌脂多糖(lipopolysaccharide,LPS)、白细胞计数(white blood cell count,WBC)、中性粒细胞百分比(neutrophilic granulocyte percentage,Neu%)、超敏C反应蛋白(hypersensitive c-reactive protein,hsCRP)、降钙素原(procalcitonin,PCT)、免疫球蛋白(immunoglobulin,Ig)G、补体(complement,C)3、白细胞介素(interleukin,IL)-6、白细胞介素(interleukin,IL)-10和肿瘤坏死因子(tumor necrosis factor,TNF)-α水平的差异。选取健康体检者(NC组)20名,单纯T2DM患者(T2DM组)20名,分别提取外周血单个核细胞(peripheral blood mononuclear cell,PBMC)并经LPS刺激,比较两组细胞中IL-6 m RNA和TNF-αmRNA表达及培养上清中IL-6和TNF-α的变化。同时,检测各组PBMC表面HLADR表达量及CD3^+CD4^+/CD3^+CD8^+的比例。【结果】SIRS^+T2DM组与单纯SIRS组比较,血清中hsCRP、IL-6、TNF-α水平降低、IL-10水平升高,差异有统计学意义(P<0.05)。与NC组比较,T2DM组PBMC经LPS刺激后产生IL-6、TNF-α减少、HLA-DR表达量减低(P<0.05)。【结论】T2DM患者并发SIRS时机体产生内毒素耐受现象。[Objective] To study the inflammatory response and endotoxin tolerance phenomenon in T2DM （type 2 diabetes mellitus） patients with systemic inflammatory response syndrome （SIRS）. [ Methods] A total of 100 SIRS patients without T2DM （SIRS group） and 100 SIRS patients with T2DM （SIRS＋T2DM group） were selected. The levels of the indicators including lipopolysaccharide （LPS）, white blood cells （WBC）, nentrophilic granulocyte percentage （Neu%）, hypersensitive c-reactive protein （hsCRP）, procalcitonin （PCT）, IgG, C3, IL-6, IL-IO and tumor necrosis factor （TNF）-ct were compared between the two groups. For PBMC （peripheral blood mononuclear cell） experiments, 20 healthy subjects （NC group） and 20 T2DM patients （T2DM group） were included. After LPS stimulation, the mRNA expressions of IL-6 and TNF-α in PBMC and protein productions of the two cytokines in PBMC supernatants were compared between the two groups. The expression of HLA-DR on the surface of PBMC and ratio of CD3＋CD4＋/CD3＋CD8＋ were analyzed. [Results] Compared with the SIRS group, the serum levels of hsCRP, IL-6 and TNF-α in the SIRS＋T2DM group were significantly decreased, whereas IL-10 level was significantly increased （P〈0.05）. Compared with the NC group, the PBMC from the T2DM group prostimulation （P〈0.05）. [Conclusion] Endotoxin tolerance appears in T2DM patients with SIRS.

关 键 词：2型糖尿病 炎症反应综合征 内毒素耐受 白介素-6 肿瘤坏死因子-α 

分 类 号：R587[医药卫生—内分泌]