2型糖尿病患者血糖管理与T细胞记忆亚群的相关性  

Correlation between glycemic control and T cell memory subsets in type 2 diabetes mellitus patients

作　　者：甘辰欣 陈明晖 王亚捷 武娇祥 方风琴 林锦骠[1] 盛慧明[1] GAN Chenxin;CHEN Minghui;WANG Yajie;WU Jiaoxiang;FANG Fengqin;LIN Jinpiao;SHENG Huiming(Department of Clinical Laboratory,Tongren Hospital,Shanghai Jiao Tong University,Shanghai 200336,China)

机构地区：[1]上海交通大学医学院附属同仁医院检验科,上海200336

出　　处：《检验医学》2025年第1期59-65,共7页Laboratory Medicine

基　　金：上海市长宁区卫生健康委员会基金项目(RCJD2021B01)。

摘　　要：目的 探讨血糖管理不良对2型糖尿病(T2DM)患者T细胞记忆亚群和活化标志物表达的影响。方法 选取2022年1月—2024年1月上海交通大学医学院附属同仁医院T2DM患者170例(T2DM组)和健康体检者85名(正常对照组)。根据糖化血红蛋白(HbA_(1c))水平将T2DM患者分为血糖管理良好(HbA_(1c)<7%)组和血糖管理不良(HbA_(1c)≥7%)组。采用流式细胞术检测所有研究对象初始T细胞(T_(Nai))、中央记忆T细胞(T_(CM))、效应记忆T细胞(TEM)和末端分化效应记忆T细胞(TEMRA)百分比和T_(CM)细胞、TEM细胞表面活化标志物(CD38、CD25、HLA-DR)的表达,并检测常规生化指标[空腹血糖、HbA_(1c)、总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)]。采用线性回归分析评估T细胞记忆亚群和活化标志物与年龄和HbA_(1c)水平的相关性。结果 与正常对照组比较,T2DM组空腹血糖、HbA_(1c)和TG水平升高(P<0.05),HDL-C水平显著降低(P<0.000 1);2个组之间TC和LDL-C差异无统计学意义(P>0.05)。T2DM组CD8^(+)T_(CM)%显著高于正常对照组(P=0.006 7),2个组之间其他T细胞记忆亚群差异均无统计学意义(P>0.05)。与正常对照组比较,T2DM组CD4^(+)CD38^(+)T_(CM)%、CD4^(+)CD25^(+)T_(CM)%、CD4^(+)HLADR+T_(CM)%、CD4^(+)CD38^(+)TEM%、CD4^(+)HLA-DR+TEM%、CD8^(+)CD38^(+)T_(CM)%、CD8^(+)HLA-DR+T_(CM)%、CD8^(+)HLADR+TEM%均降低(P<0.05)。与血糖管理良好组比较,血糖管理不良组CD8^(+)T_(CM)%升高(P<0.05),CD4^(+)CD38^(+)T_(CM)%显著降低(P<0.000 1),CD4^(+)CD38^(+)TEM%降低(P<0.05)。T2DM组CD4^(+)CD38^(+)T_(CM)%与HbA_(1c)水平和年龄均呈负相关(r值分别为-0.512 6、-0.234 2,P值分别为<0.000 1、0.002 1)。结论 T2DM患者血糖管理不良对T细胞的免疫功能有显著影响,CD4^(+)T_(CM)细胞表面CD38表达随T2DM患者HbA_(1c)水平的升高而降低。Objective To investigate the influence of poor glycemic control in type 2 diabetes mellitus(T2DM)patients on T cell memory subsets and immune marker expression.Methods Peripheral blood samples were collected from 170 T2DM patients(T2DM group)and 85 healthy subjects(healthy control group)in Tongren Hospital of Shanghai Jiao Tong University from January 2022 to January 2024.According to glycated hemoglobin A_(1c)(HbA_(1c))levels,T2DM patients were classified into 2 groups,patients with good glycemic control(HbA_(1c)<7%)and patients with poor glycemic control(HbA_(1c)≥7%).Flow cytometry was used to assess the proportion of T cell memory subsets,distinguishing between naive T cell(T_(Nai)),central memory T cell(T_(CM)),effector memory T cell(TEM)and terminally differentiated effector memory T cell(TEMRA)subgroups.The expressions of T_(CM) and TEM membrane molecules(CD38,CD25 and HLA-DR)were determined.Biochemical indicator determination results were collected,including fasting plasma glucose,HbA_(1c),total cholesterol(TC),triglyceride(TG),low-density lipoprotein cholesterol(LDL-C)and high-density lipoprotein cholesterol(HDL-C).Linear regression was used to assess the correlation between T cell memory subsets and membrane molecules and patients'age and HbA_(1c) level.Results Compared with healthy control group,T2DM group showed increased levels of fasting plasma glucose,HbA_(1c) and TG(P<0.05)and a decreased level of HDL-C(P<0.0001).There was no statistical significance in TC and LDL-C between the 2 groups(P>0.05).T2DM patients showed an increased percentage of CD8^(+)T_(CM) cells(P=0.0067).There was no statistical significance in the other T cell memory subsets between the 2 groups(P>0.05).Compared with healthy control group,in T2DM group CD4^(+)CD38^(+)T_(CM)%,CD4^(+)CD25^(+)T_(CM)%,CD4^(+)HLA-DR+T_(CM)%,CD4^(+)CD38^(+)TEM%,CD4^(+)HLA-DR+TEM%,CD8^(+)CD38^(+)T_(CM)%,CD8^(+)HLA-DR+T_(CM)%and CD8^(+)HLA-DR+TEM%were decreased(P<0.05).Compared with T2DM patients with good glycemic control,T2DM patients with poor glycem

关 键 词：T细胞 CD38 2型糖尿病 血糖管理 

分 类 号：R446.1[医药卫生—诊断学]