合并糖尿病的早发冠心病患者T淋巴细胞表面共刺激分子表达的研究  

Expression of costimulatory molecules on the surface of T lymphocytes in patients with premature coronary heart disease complicated with diabetes

作　　者：操明 吴晓芬 阮磊 张存泰[1] Cao Ming;Wu Xiaofen;Ruan Lei;Zhang Cuntai(Department of Geriatrics,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院综合科,武汉430030

出　　处：《中华实验外科杂志》2021年第10期2022-2024,共3页Chinese Journal of Experimental Surgery

基　　金：国家重点研发计划项目(2020YFC2008000);湖北省自然科学基金(2020CFB476)。

摘　　要：目的探讨CD4+CD28null T淋巴细胞及炎性因子γ-干扰素(IFN-γ)及肿瘤坏死因子-α(TNF-α)在合并糖尿病的早发冠心病(PCHD)患者发病机制中的作用。方法入选50例经冠状动脉造影确认的早发冠心病患者(男性≤55岁,女性≤65岁),根据1999年WHO糖尿病的诊断标准,将入选者分为单纯早发冠心病组(28例)和2型糖尿病合并早发冠心病组(22例)。所有研究对象均通过流式细胞术检测外周血中CD4+CD28null T淋巴细胞的数量,采用酶联免疫吸附试验(ELISA)法测定患者血清中炎性因子IFN-γ及TNF-α水平;对比分析两组患者外周血CD4+CD28null T淋巴细胞的数量、炎性因子水平,及其与冠状动脉病变程度的相关性。采用独立样本t检验和χ^(2)检验。结果 2型糖尿病合并PCHD患者外周血中CD4+CD28null T淋巴细胞的数量[(7.72±5.21)%]高于单纯PCHD组患者[(4.43±2.95)%],差异有统计学意义(t=-2.646,P<0.05);2型糖尿病合并PCHD患者血清中炎性因子IFN-γ[(2.37±1.33) pg/ml]及TNF-α水平[(2.82±1.18) pg/ml]均高于单纯PCHD组患者[(1.00±0.23)、(1.79±0.43) pg/ml],差异有统计学意义(t=-4.796、-4.255,P均<0.05)。单纯PCHD患者以单支病变为主,2型糖尿病合并PCHD患者以多支病变为主(χ^(2)=6.411,P<0.05);多支病变的PCHD患者血清IFN-γ[(2.01±1.12) pg/ml]、TNF-α水平[(2.55±1.25) pg/ml]高于单支病变的PCHD患者[(1.22±1.00)、(1.96±0.53) pg/ml],差异有统计学意义(t=-2.638、-2.146,P均<0.05)。结论合并糖尿病的PCHD患者较单纯PCHD患者的冠状动脉病变范围增大,可能与T淋巴细胞表面共刺激分子表达丢失及其导致的免疫性炎症有关。Objective To investigate the role of CD4+CD28null T lymphocytes and inflammatory cytokines interferon-γ(IFN-γ)and tumor necrosis factor-α(TNF-α)in the pathogenesis of premature coronary heart disease(PCHD)complicated with diabetes.Methods A total of 50 patients(male≤55 years old,female≤65 years old)with PCHD confirmed by coronary angiography were selected.According to the diagnostic criteria of DIABETES(WHO 1999),the patients were divided into the pure PCHD group(28 cases)and the PCHD group with type 2 diabetes(DM-PCHD,22 cases).The number of CD4+CD28null T lymphocytes in peripheral blood was detected by flow cytometry,and the levels of inflammatory cytokines IFN-γand TNF-αin serum were measured by enzyme linked immunosorbent assay(ELISA),and their correlation with the lesion degree of coronary artery was analyzed.The two groups were compared by independent sample t test andχ^(2)test.Results The number of CD4+CD28null T lymphocytes in peripheral blood of DM-PCHD patients was significantly higher than that of PCHD patients[(7.72±5.21)%vs.(4.43±2.95)%,t=-2.646,P<0.05],and the serum levels of inflammatory factors IFN-γand TNF-αwere significantly higher than those of the former group[(2.37±1.33)pg/ml vs.(1.00±0.23)pg/ml,(2.82±1.18)pg/ml vs.(1.79±0.43)pg/ml,t=-4.796,-4.255,both P<0.05].The single-obstruction rate was dominant in PCHD patients,while in DM-PCHD patients,the multiple-obstructions rate was dominant(χ^(2)=6.411,P<0.05).The serum levels of IFN-γand TNF-αin PCHD patients with multiple-obstructions were significantly higher than patients with single-obstruction[(2.01±1.12)pg/ml vs.(1.22±1.00)pg/ml,(2.55±1.25)pg/ml vs.(1.96±0.53)pg/ml,t=-2.638,-2.146,both P<0.05].Conclusion Coronary pathogenic changes was more severe in DM-PCHD patients than pure PCHD patients,which may be related to the loss of costimulatory molecules on the T lymphocyte surface and the resulting immune-inflammation effection.

关 键 词：糖尿病 早发冠心病 T淋巴细胞 炎症 

分 类 号：R541.4[医药卫生—心血管疾病] R587.2[医药卫生—内科学]