初发1型糖尿病儿童辅助性Th1细胞因子紊乱相关因素分析

目的：检测初发1型糖尿病患儿IL-1β、IL-12、IL-18、TNF-α等细胞因子水平，并分析其与感染、起病时间等临床指标相关性。方法：选择初发1型糖尿病患儿33例为病例组，依据外周血白细胞（WBC）水平将33例患儿分为WBC增高组和WBC正常组；另选取健康体检儿童27例为对照组。应用酶联免疫吸附法检测血清IL-1β、IL-12、IL-18、TNF-α等细胞因子水平；同时检测病例组患儿血气pH值、血糖、血乳酸、果糖胺、外周血白细胞及中性粒细胞等各临床指标水平。结果：病例组细胞因子 IL-12水平高于对照组（P＜0.001）。病例组IL-18水平与发病时间呈负相关（r=-0.413，P=0.015）；中性粒细胞与IL-1β水平呈正相关（r=0.413，P=0.023）；外周血WBC与IL-18水平亦呈正相关（r=0.352，P=0.038）。WBC增高组细胞因子IL-1β、IL-12、IL-18水平高于WBC正常组(均P＜0.05)。结论：1型糖尿病患儿存在Th1细胞分泌细胞因子紊乱，感染可进一步提高细胞因子的分泌水平，可能推动了早期糖尿病起病过程。

Factors associated with Th1 cytokine disorders in children with newly diagnosed type 1 diabetes

Objective To measure levels of cytokines including IL-1β,IL-12,IL-18 and TNF-α in children with newly diagnosed type 1 diabetes and to analyze their correlation with clinical indices such as infection and onset time.Methods A total of 33 children with newly diagnosed type 1 diabetes were assigned to the case group,and 27 healthy children to the control group.The case group was further divided into increased white blood cell(WBC) and normal WBC subgroups according to peripheral WBC level.The serum levels of cytokines including IL-1β,IL-12,IL-18 and TNF-α were measured by enzyme-linked immunosorbent assay.Blood pH,blood sugar,blood lactate,fructosamine,peripheral leukocytes and neutrophils and some other clinical indices were also measured.Results The level of IL-12 in the case group was higher than in the control group(P<0.001).In the case group,the level of IL-18 was negatively correlated with onset time(r=0.413,P=0.015),the neutrophil count was positively correlated with IL-1β level(r=0.413,P=0.023) and the WBC count was positively correlated with IL-18 level(r=0.352,P=0.038).IL-1β,IL-12 and IL-18 levels in the increased WBC subgroup were higher than in the normal WBC subgroup(P<0.05 for all comparisons).Conclusions Cytokine secretion disorders of Th1 cells exist in children with type 1 diabetes.Infections may induce cytokine secretion and might contribute to the early onset of diabetes.