胰岛素强化治疗对2型糖尿病患者外周血调节性T细胞影响的研究  

The effect of insulin therapy on regulatory T cells in patients with type 2 diabetes mellitus

作　　者：程亮 胡蕴[2] 钟易 杨帆 刘晓梅[2] 毛晓明[2] CHENG Liang;HU Yun;ZHONG Yi(Department of Endocrinology,Affiliated Huai’an Hospital ofXuzhou Medical College,Huaian 221004,China)

机构地区：[1]徐州医科大学附属淮安医院内分泌科,221004 [2]南京医科大学附属南京医院内分泌科 [3]盐城市第一人民医院内分泌科

出　　处：《中国糖尿病杂志》2021年第10期727-732,共6页Chinese Journal of Diabetes

基　　金：江苏省自然科学基金青年项目(BK20170136)。

摘　　要：目的观察Ins强化治疗对T2DM患者外周血调节性T细胞(Tregs)的影响。方法选取113例T2DM患者(T2DM组)及28名体检健康人(NC组),比较两组生化指标和外周血Th1、Th2、Tregs差异。给予T2DM患者持续胰岛素皮下输注(CSII)治疗2周,观察外周血Th1、Th2、Tregs变化,分析Tregs变化的影响因素。使用免疫磁珠法分离Tregs和效应T细胞(Teffs),分别在不同环境下共培养,观察Tregs对Teffs的抑制功能。结果与NC组比较,T2DM组外周血Tregs比例降低[2.25(1.52,3.00)vs 0.80(0.50,1.10),P<0.01],Th1比例升高[16.30(14.22,21.55)vs20.70(16.20,28.15),P<0.01]。Spearman相关分析显示,T2DM患者外周血Tregs比例与HDL-C呈正相关(P=0.023),与FPG、HbA1c、TG和LDL-C呈负相关(P<0.001)。CSII治疗后,T2DM组较治疗前外周血Tregs比例升高[0.80(0.50,1.10)vs 1.10(1.00,1.20),P<0.01],Th1比例降低[20.70(16.20,28.15)vs 18.10(16.80,21.50),P<0.01]。多元逐步回归分析显示,HOMA-β是外周血Tregs变化的影响因素。体外高糖环境下Tregs功能受损,Ins能逆转高糖对Tregs功能的抑制作用。结论T2DM患者体内Tregs比例下降,Ins干预可提高Tregs比例,改善其免疫调节功能。Objective To investigated the effects of insulin therapy on circulating regulatory T cells(Tregs)in patients with type 2 diabetes mellitus(T2DM).Methods Patients with newly diagnosed T2DM(T2DM group,n=113)and healthy volunteers(NC group,n=28)were enrolled in this study.The differences of biochemical parameter and circulating Th1,Th2 and Tregs cells between the two groups were compared.Patients with T2DM were treated with CSII for two weeks.Then the changes of circulating Th1,Th2 and Tregs cells were evaluated,and the influencing factors for Tregs cells were analyzed.Tregs and Teffs cells were isolated by immunomagnetic separation,and co-cultured under normal glucose,high glucose,high glucose+insulin and normal glucose+insulin,respectively to detect the inhibitory function of Tregs cells on Teffs cells.Results Compared with NC group,the percentage of Tregs cells was decreased[0.80(0.50,1.10)vs 2.25(1.52,3.00),P<0.01],and the percentage of Th1 cells was increased in T2DM group[20.70(16.20,28.15)vs 16.30(14.22,21.55),P<0.01].Spearman correlation analysis revealed a positive correlation between the percentage of Tregs cells and HDL-C(P=0.023),and a negative correlations between the percentage of Tregs cells and fasting plasma glucose(FPG),HbA_(1)c,triglyceride(TG)and LDL-C(P<0.001).After CSII treatment,the percentage of Tregs cells was increased[0.80(0.50,1.10)vs 1.10(1.00,1.20),P<0.01],while the percentage of Th1 cells was decreased in T2DM group[20.70(16.20,28.15)vs 18.10(16.80,21.50),P<0.01].Linear regression analysis revealed that HOMA-βwas influencing factor for changes in Tregs cells.In vitro,the function of Tregs cells was inhibited by high glucose.However,after being treated with insulin,the function of Tregs cells was improved.Conclusion The percentage of Tregs cells was decreased in patients with T2DM,however,insulin therapy reversed the decreased percentage of Tregs cells,and restored the immune regulation function in Tregs cells.

关 键 词：糖尿病 2型 胰岛素治疗 调节性T细胞 

分 类 号：R587.1[医药卫生—内分泌]