CD4+CD28null T细胞与糖尿病微血管病变的关系研究

目的 探讨CD4+CD28null T细胞与糖尿病微血管病变的关系。 方法 选取内分泌科141例2型糖尿病患者，按是否存在微血管病变分为单纯糖尿病组(T2DM组)、糖尿病视网膜病变组(DR组)、糖尿病肾病组(DN组)、糖尿病视网膜病变合并糖尿病肾病组(DR+DN组)。另选择台州医院体检中心的26名健康体检者为正常对照组。比较分析各组CD4+CD28null T细胞的表达及临床特点，并分析影响糖尿病微血管病变的相关因素。 结果 与对照组相比，各糖尿病组CD4+CD28null T细胞的表达均明显升高(χ2=19.98，P＜0.01)。DR组、DN组、DR+DN组与T2DM组相比，CD4+CD28null T细胞的表达均升高(Z=-2.19、-2.87、-2.67，均P＜0.05)，炎症指标CRP也升高(Z=-3.11、-2.36、-2.86，均P＜0.05)。而DR组、DN组、DR+DN组之间CD4+CD28null T细胞的表达和CRP的差异无统计学意义。Logistic回归分析显示CD4+CD28null T细胞的表达、CRP及腰围是糖尿病微血管病变的独立影响因素。 结论 2型糖尿病患者CD4+CD28null T细胞亚群的表达高于健康体检者，而存在微血管病变的2型糖尿病患者具有更高的CD4+CD28null T细胞亚群的表达。CD4+CD28null T细胞可独立影响糖尿病微血管病变的进展。 

Relationship between CD4+ CD28null T cell and diabetic microangiopathy

Objective To investigate the relationship between CD4+CD28null T cell and diabetic microangiopathy. Methods One hundred and forty-one patients with type 2 diabetes were selected in the endocrinology department.According to the presence of microvascular disease,these patients were divided into four groups:the type 2 diabetes patients without documented microangiopathy(T2DM) group;the diabetic retinopathy(DR) group;the diabetic nephropathy(DN) group;the group with diabetic retinopathy and nephropathy(DR+DN) group.The healthy control group was consisted of 26 subjects.The expression of CD4+CD28null T cells of these groups were compared and analyzed to find out the related factors which affects diabetic microangiopathy. Results Compared with normal control group,the expression of CD4+CD28null T cell of all diabetic groups are significantly increased(χ2=19.98,P＜0.01).Compared with T2DM group,the expression of CD4+CD28null T cell of groups DR,DN and DR+DN are significantly increased(Z=-2.19,-2.87,-2.67,P＜0.05),and CRP of these groups are also significantly increased(Z=-3.11,-2.36,-2.86,P＜0.05).But the differences of the expression of CD4+CD28null T cell and CRP between groups DR,DN and DR+DN have no statistical significance.The logistic regression analysis shows that the duration,the expression of CD4+CD28null T cell,CRP and waistline are the independent risk factors for diabetic microangiopathy. Conclusion The expression of CD4+CD28null T cell of type 2 diabetes patients is higher than that of the healthy subjects.Further,these diabetes patients with microangiopathy have a higher expression.CD4+CD28null T cell may affect the progress of diabetic microangiopathy independently.