外周血NK细胞和细胞因子在妊娠期糖尿病患者中的表达及临床意义  

Expression and Clinical significance of peripheral blood NK cell and cytokine in patients with gestational diabetes mellitus

作　　者：沈梦尘 林晶 钟建容 王曦 陈蕾 SHEN Meng-chen;LIN Jing;ZHONG Jian-rong;WANG Xi;CHEN Lei(Department of Obstetrics and Gynecology,the Sixth Medical Center of Chinese PLA General Hospital,Beijing 100048;Navy Clinical College,Anhui Medical University,Beijing 100048;The Fifth School of Clinical Medicine,Anhui Medical University,Hefei 230032;School of Medicine,South China University of Technology,Guangzhou 510006)

机构地区：[1]中国人民解放军总医院第六医学中心妇产科,北京100048 [2]安徽医科大学海军临床学院,北京100048 [3]安徽医科大学第五临床学院,合肥230032 [4]华南理工大学医学院,广州510006

出　　处：《生殖医学杂志》2023年第9期1329-1334,共6页Journal of Reproductive Medicine

基　　金：首都卫生发展科研专项(首发2020-1-5112)。

摘　　要：目的探讨外周血中NK细胞的水平与妊娠期糖尿病(GDM)发生发展的相关性。方法选取2020年12月至2021年10月于中国人民解放军总医院第六医学中心妇产科确诊的30例GDM患者作为GDM组,另选择同期健康的40例孕妇作为对照组。通过流式细胞仪检测分析两组孕妇NK细胞占比及各亚群(CD3-CD56 bright NK细胞、CD3-CD56 dim NK细胞)分布,以及外周血细胞因子白细胞介素10(IL-10)、肿瘤坏死因子-α(TNF-α)、粒细胞-巨噬细胞集落刺激因子(GM-CSF)、干扰素-γ(IFN-γ)、穿孔素和颗粒酶B的水平,比较两组间各指标差异。采用Spearman检验GDM发生的独立危险因素与外周血细胞因子水平的相关性。结果两组患者间的糖化血红蛋白(HbA1c)、空腹胰岛素(FINS)、空腹血糖(FPG)、餐后1 h血糖(OGTT-1h)、餐后2 h血糖(OGTT-2h)、胰岛素抵抗指数(HOMA-IR)相比,差异均具有统计学意义(P<0.05)。与对照组相比,GDM组外周血中NK细胞占比、CD3-CD56^(dim)NK细胞亚群占比显著升高(P<0.05);而CD3-CD56^(bright)NK细胞亚群在两组中分布无统计学差异(P>0.05)。外周血细胞因子比较中,GDM组的IFN-γ和穿孔素水平显著高于对照组(P<0.05),IL-10、TNF-α、GM-CSF及颗粒酶B水平在两组间的差异均无统计学意义(P>0.05)。Spearman相关分析结果显示,IFN-γ水平与FINS(r=0.280)、HOMA-IR(r=0.252)均呈正相关(P<0.05);穿孔素水平与HOMA-IR(r=0.311)呈正相关(P<0.05);FINS、HOMA-IR水平与IL-10、TNF、GM-CSF、颗粒酶B之间无显著相关性(P>0.05)。结论GDM患者外周血中的NK细胞数量增加、活性增强,IFN-γ和穿孔素水平均呈高表达样,且与胰岛素抵抗的发生具有密切关系,进而可能影响妊娠期糖尿病的发生。Objective:To investigate the relationship between the NK cytokine levels in peripheral blood and the development of gestational diabetes mellitus(GDM).Methods:Thirty patients with GDM diagnosed at the Department of Obstetrics and Gynecology of the Sixth Medical Center of Chinese PLA General Hospital from December 2020 to October 2021 were selected as the GDM group,and 40 healthy pregnant women in the same period were selected as the control group.The proportion of NK cells,the distribution of CD3-CD56^(bright)NK cells and CD3-CD56^(dim)NK cells,and the levels of peripheral blood cytokines including interleukin-10(IL-10),tumor necrosis factor-α(TNF-α),granulocyte-macrophage colony-stimulating factor(GM-CSF),interferon-γ(IFN-γ),perforin and granzyme B were detected and analyzed by flow cytometry.The correlation between independent risk factors of GDM and peripheral blood cytokine levels was further tested by Spearman analysis.Results:There were significant differences in glycated hemoglobin,fasting insulin(FINS),fasting blood glucose(FPG),1-hour postprandial blood glucose(OGTT-1h),2-hour postprandial blood glucose(OGTT-2h),and insulin resistance index(HOMA-IR)between the two groups(P<0.05).Compared with the control group,the proportion of NK lymphocytes and CD3-CD56 dim NK cells in the peripheral blood of GDM group was significantly higher than that of the control group(P<0.05),but there was no significant difference in the proportion of CD3-CD56 bright NK cells between the two groups(P>0.05).The levels of IFN-γand perforin in GDM group were significantly higher than those in control group(P<0.05).There was no significant difference in the levels of IL-10,TNF-α,GM-CSF and granzyme B between the two groups(P>0.05).Spearman correlation analysis results show that the IFN-γlevel was positively correlated with FINS(r=0.280)and HOMA-IR(r=0.252),and the perforin level was positively correlated with HOMA-IR(r=0.311)(P<0.05).There was no significant correlation between the levels of FINS,HOMA-IR and IL-10,TNF,GM-CSF,

关 键 词：妊娠期糖尿病 自然杀伤细胞 细胞因子 炎症 

分 类 号：R715.3[医药卫生—妇产科学]